University  of  California  •  Berkeley 


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A.a«.^-.jyu^' 


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DISSERTATION 


ON  THE 


INFLUENCE  OF  A  CHANGE  OF  CLIMATE 


IN 


CURING  DISEASES. 


DISSERTATION 


ON  THE 


Influence  of  a  Change  of  Climate  in  Curing 
Diseases^ 


BY  PROFESSOR  GREGORY, 

OF  EDINBURGH. 


Translated  from  the  original  Latin,  and  enlarged  with  occasional  Notes: 
BY  WILLIAM  P.  C.  BARTON,  M.  D. 


"  Pessimum  segro  est  coelura  quod  segrum  fecit;  adeo  ut  in  id  quoque  genua^ 
quod  natura  pejus  est,  in  hoc  statu,  salubris  mutatio  sit." 

C£Lsus  ns  Rs  Mkdica. 


PHILADELPHIA: 

PUBLISHED  BY  THOMAS  DOBSON, 

AT  THE  STONE  HOUSE,  NO.  41,  SOUTH  SECOND-STREST. 

WilUam  Fry,  Printer, 

1815. 


District  of  Pennsylvania,  to  wit: 

*********     BE  IT  REMEMBERED,  That  on  the  second  day  of  May, 

I   Seal.    *  in  the  thirty-ninth  year  of  the  independence  of  the  United 

*«««««««»  Stites  of  America,   A.  D.  1815,   Thomas  Dobson,  of  the 

said  district,  hath  deposited  in  this  office  tl»e  title  of  a  book,  the  right 

whereof  he  claims  as  proprietor,  in  the  words  following,  to  wit: 

**  A  Dissertation  on  the  Influence  of  a  Change  of  Climate  in  Cur- 
ing Diseases;  by  Professor  Gregory,  of  Edinburgh.  Translated 
from  the  original  Latin,  and  enlarged  with  occasional  Notes: 
By  William  P.  C.  Barton,  M.  D. 

*  Pessimum  3cgro  est  ccclum  quod  segrum  fecit;  adeo  ut  in  id  quo- 
que  genus,  quod  natura  pejus  est,  in  hoc  statu,  salubris  mutatio 
sit.' — Celsus  de  Re  JMedica** 

In  conformity  to  the  act  of  the  congress  of  the  United  States,  inti- 
tuled, ••  An  act  for  the  encouragement  of  learning,  by  securing  the 
copies  of  maps,  charts,  and  books,  to  the  authors  and  proprietors  of 
such  copies,  during  the  times  therein  mentioned.*' — And  also  to  the 
act,  entitled,  *•  An  act  supplementary  to  an  act,  entitled,  '  An  act  for 
the  encouragement  of  learning,  by  securing  the  copies  of  maps,  charts, 
and  books,  to  the  authors  iiud  proprietors  of  such  copies  during  the 
times  therein  mentioned,'  and  extending  the  benefits  thereof  to  the 
arts  of  designing,  engraving,  and  etching  historical  and  other  prints.'* 

D.CALDWELL, 
Clerk  of  the  District  of  Pennsylvania. 


TO 

NATHANIEL  CHAPMAN,  M.D. 

PROFESSOR  OF  MATERIA  MEDICA  IN  THE  UNIVERSITY  OF 

PENNSYLVANIA:  WHOSE  TALENTS  AND  URBANITY 

HAVE  ELEVATED  HIM  TO  THE  HIGHEST 

EMINENCE  IN  HIS  PROFESSION; 


IN  GRATEFUL  ACKNOWLEDGMENT  OF  MANY  ACTS  OF 

FRIENDLINESS,  AND  IN  EVIDENCE  OF  ESTEEM, 

JS  RESPECTFULLY  DEDICATED 

BY  HIS  FRIEND, 


THE  TRANSLATOR. 


CONTENTS. 


Page 
Section  I.— -General  observations  relative  to  the  effects 

of  climate  on  the  human  constitution,  and  ^specially  re- 
specting the  effect  of  that  of  Great  Britain  on  the  inha- 
bitants.— Remarks  on  the  constitution  of  the  air,  and 
its  modus  operandi  on  the  solids  and  fluids  of  the  body; 
also,  of  the  disorders  induced  by  its  inclemency,  and 
the  sudden  vicissitudes  to  which  it  is  liable.— Of  the 
effects  of  sailing  on  the  system,  and  the  peculiar  kind 
of  nausea,  vomiting,  and  exercise,  arising  from  it.— 
Observations  tending  to  prove  that  a  change  of  climate 
may  reasonably  be  expected  to  cure  many  obstinate 
chronick  diseases,  and  more  especially  those  endemi- 
cal  to  the  inhabitants  of  Great  Britain IT 

Section  II. — Of  the  nature  and  symptoms  of  pulmonary 
consumption,  and  its  similarity  or  identity  with  scrofula. 

Of  the  different  notions  of  physicians  respecting  the 

curableness  and  incurableness  of  genuine  phthisis.— 
Of  the  effects  of  wounds  and  other  injuries  of  the 
lungs,  on  that  viscus.- — Of  the  remote  and  proximate 
causes  of  consumption,  and  the  reasons  that  may  be 


8 

Page 
deduced  from  them,  in  favour  of  a  change  of  climate 
upon  the  diseases.— Of  the  curative  effects  of  travel- 
ling, riding  on  horseback  and  sea-voyages 76 

Section  III.— .Of  the  causes  of  hypochondria,  especially 
its  origin  from  the  effects  of  climate,  diet,  and  mode  of 
life. — Its  various  symptoms.— Its  connection  with  the 
haemorrhoidal  flux  and  its  affinity  to  this  disease,  deduced 
from  the  similarity  of  its  causes.-— The  general  absence 
of  any  praeternatural  appearances  in  the  dissection  of 
the  dead  bodies  of  hypochondriacks.— Sometimes  tur- 
gescence  in  the  mesenterick  veins  observable.— The 
different  remedies  for  this  disease. — The  beneficial 
effects  of  riding  on  horseback,  especially  when  conjoin- 
ed with  a  change  of  climate 155 

Section  IV. — Of  gout.— Of  the  effects  of  a  cold  and 
humid  climate  on  arthritick  constitutions,  and  the  ge- 
neral incfficacy  of  the  remedies  used  in  this  disease. — 
The  advantage  of  a  change  of  climate  over  all  other 
remedies  in  this  complaint,  particularly  from  a  cold  to 
a  warm  one,  deduced  from  the  effects  of  travelling  and 
warm  air,  in  promoting  a  free  and  healthy  determina- 
tion of  the  fluids  to  the  skin,  especially  in  old  persons. 
— Also  the  beneficial  effects  of  a  mild  climate  on  the 
disorders  of  the  stomach,  so  intimately  connected  and 
almost  always  combined  with  gout. — Arguments  in 
favour  of  a  change  ef  climate  in  gout,  inferred  from  a 
consideration  of  the  remote  causes  of  the  disease Of  ' 


9 

Page 
its  effects  in  averting  the  ill  consequences  of  repressed 

gout,  which  generally  succeed  the  use  of  other  reme- 
dies  176 

Section  V. — Of  invigorating  old  age— The  signs  and 
effects  of  declining  life  in  old  persons,  and  the  particu- 
lar consequences  of  the  depreciated  functions  of  the 
system  .-^Reasons  why  a  change  of  climate  may  be  ex- 
pected to  relieve  them,  and  produce  a  general  invigora- 
tion  of  the  fading  body.— Of  the  injurious  effect  of  a 
cold  and  humid  climate  upon  old  people,  and  the  ad- 
vantages to  be  derived  from  travelling  to  warm  coun- 
tries      .     .  190 


B 


PREFACE. 


The  original  of  the  following  Dissertation,  is  from 
the  classick  pen  of  Dr.  Gregory,  professor  of  medi- 
cine at  Edinburgh,  and  author  of  the  Conspectus. 
It  was  written  for  his  inaugural  Thesis  in  the  year 
1774,  under  the  title  "  De  Morbis  Coeli  Mutatione 
Medendis,"  enlarged  and  amended  by  the  author 
in  1776,  and  republished  in  1785  in  the  "  Thesau- 
rus Medicus  Edinburgensis  Novus."  It  is  from  this 
last  edition  that  the  translation  is  made.  This  dis- 
sertation, besides  its  classical  Latinity,  contains  many 
useful  observations  and  important  facts  on  the  sub- 
ject of  which  it  treats.  The  reasoning  of  the  author 
is  sound,  his  arguments  pertinent,  and  his  conclu- 
sions correct.  He  has  treated  an  interesting  subject 
judiciously  and  with  ability,  and  satisfactorily  de- 
monstrates the  powerful  operation  of  climate  on  the 
physical  and  moral  constitutions.  The  pathology  of 
this  work  is  not  the  least  important  part  of  it.  The 


12 

arguments  in  favour  of  a  change  of  climate,  in  the 
treatment  of  many  of  the  diseases  which  afflict  the 
human  race,  are  all  logically  deduced  from  an  at- 
tentive consideration  of  the  causes  and  symptoms 
of  the  diseases  in  which  the  author  deems  it  expe- 
dient to  recommend  it:  and  it  is  believed  that  the 
translation  may  be  useful  as  a  mean  of  giving  in- 
formation, on  a  subject  not  particularly  treated  in 
any  other  medical  work  in  the  English  language. 
All  the  notes  added  are  by  the  translator,  and  they 
are  intended  to  convey  such  observations  illustra- 
tive of  the  text,  as  his  practical  experience,  while  a 
surgeon  in  the  navy,  enables  him  to  offer.  With 
regard  to  the  mere  diction  of  the  English  version, 
but  one  end  has  been  aimed  at,  which  is,  to  render 
into  intelligible  English,  what  was  believed  to  be 
the  true  meaning  of  the  author,  and  never  deviating 
even  from  the  actual  phraseology  of  the  original, 
excepting  in  those  instances  where  an  adherence  to 
it  would  have  been  incompatible  with  the  idiom  of 
our  own  tongue.  As  no  liberties  have  been  taken 
with  the  original,  but  have  been  on  the  contrary 
sedulously  avoided,  the  reader  must  not  look  for, 
and  he  certainly  will  not  find,  the  embellishments 
of  style.  If  the  translator  has  succeeded  in  present- 


13 

ing  the  publick  with  a  literal  and  faithful  version  of 
the  original  into  clear  and  unvarnished  English,  he 
will  have  accomplished  his  design,  and  be  satisfied. 
He  has  not  relinquished  his  intention,  announced 
some  time  since,  of  presenting  the  medical  publick 
with  an  English  translation  of  the  Conspectus  Mc- 
dicinae  Theoreticae.  An  engagement  with  a  book- 
seller, is  all  that  is  necessary  to  enable  him  to  com- 
ply with  his  promise. 


THE  TRANSLATOR. 


No.  222,  Walnut-street, 
Philadelphia. 


TABLE  OF  ERRATA. 

Page  38,  line  2  from  the  bottom  of  note,  for  vascillancy,  read  vaciUancy. 

Page  41,  line  4  of  note  from  the  top,  for  necisse,  read  necesse. 

Page  63,  line  7  from  the  top,  for  vascUlation,  read  vacUlatton, 

Page  113,  line  10  of  the  note,  for  patient,  vesA patients. 

Page  131,  line  6  from  the  bottom,  for  vascUlating,  read  vacillating. 

Page  83,  line  1  of  the  note,  leave  out  the  word  General,  between  parenthesis. 

Page  171,  line  4  from  the  bottom,  for  concommitants,  read  concomitants. 

Page  174,  lines  5  and  7  from  the  top,  for  vicera,  read  viscera* 

3*age  174,  line  9  from  the  top,  for  Carribeans  read  Caribbean. 


A  DISSERTATION,  &c. 


DISSERTATION 

OK 

THE  INFLUENCE  OF  A  CHANGE  OF  CLIMATE. 
IN  CURING  DISEASES. 


SECTION  I. 

General  Observations  relative  to  the  effects  of  Climate  on 
the  Human  Constitution,  and  especially  respecting  the  ef- 
fect of  that  of  Great  Britain  on  the  Inhabitants. — Remarks 
on  the  Constitution  of  the  Air,  and  its  modus  operandi  on 
the  Solids  and  Fluids  of  the  body;  also,  of  the  Disorders 
induced  by  its  inclemency,  and  the  sudden  vicissitudes  to 
which  it  is  liable. — Of  the  effects  of  Sailing  on  the  Sys- 
tem, and  the  peculiar  kind  of  Nausea,  Vomiting,  and  Ex- 
ercise, arising  from  it. — Observations  tending  to  prove 
that  a  change  of  Climate  may  reasonably  be  expected  to 
cure  many  obstinate  Chronick  Diseases,  and  more  especi- 
ally those  Endemical  to  the  inhabitants  of  Great  Britain. 

Many  of  the  diseases  which  afflict  the  human  race, 
are  endcmial  to  certain  countries;  while  in  others 
they  rarely,  or  perhaps  never  occur.  The  tempera- 
ture of  the  atmosphere  certainly  produces  various 
affections  of  the  human  system,  so  that  the  most  of 
those  disorders  may  be  easily  attributed  to  the  per- 

C 


•  18 

hicious  properties  of  the  air,  aided  in  their  operatioa 
on  the  body,  by  the  influeHce  of  climate.  There  is  a 
surprising  difference  in  the  mental  constitutions,  as 
well  as  in  the  corporeal  systems,  of  the  inhabitants  of 
different  countries;  and  in  addition  to  this  circum- 
stance, each  revolution  of  the  seasons  of  the  year  is 
accompanied  by  a  train  of  diseases  peculiar  to  itself, 
which  it  ushers  in  on  its  approach.  Climate,  and 
the  state  of  the  air,  manifesdy  induce  a  predisposi- 
tion to  many  disorders,  and  copiously  abound  also, 
as  is  very  evident,  with  the  exciting  causes  of  dis- 
ease. We  well  know  that  winter  produces  various 
chronick  complaints,  which  resist  every  medicine  that 
may  be  exhibited  for  their  relief,  during  a  continu- 
ance of  that  season;  yet  these  very  disorders  are 
cured  with  the  utmost  facility  on  the  approach  of 
summer.  It  is  a  well  ascertained  fact  too,  that  there 
is  so  great  a  variation  in  the  state  of  the  air  in  dif- 
ferent countries,  nay,  even  in  the  same  country  dur- 
ing the  different  seasons  of  the  year,  that  the  effects 
it  produces  on  the  system,  are  entirely  dissimilar. 
Hence  it  is  evident,  that  many  disorders  originating 
from  an  intemperate  climate,  might  be  prevented  and 
cured  by  a  change  of  air.  That  this  is  incontroverti- 
bly  true,  we  infer  from  the  fact:  that  innumerable 


1^ 

maladies,  after  having  baffled  all  the  powers  of  the 
medicines  that  had  been  employed  for  their  cure, 
disappear  spontaneously,  or  become  mitigated,  by 
changing  the  climate,^  or  upon  a  revolution  of  the 
season;  and  we  are  confirmed  in  the  verity  of  this 
proposition,  by  the  opinions  of  the  physicians  of  an- 
cient times,  who  accord  with  those  of  our  own  day, 
in  believing  that  a  change  of  climate  will  prove  emi- 
nently beneficial  in  a  variety  of  complaints,  that  ar« 
curable  with  difficulty  by  any  other  means. 

In  this  essay,  we  shall  attempt  to  advance  some 
opinions  relative  to  certain  disorders  endemial  to  our 
climate,  and  respecting  the  feasibility  of  their  cure 
by  a  change  of  air.  We  will,  however,  previously 

1  Every  naval  surgeon  must  have  had  occasioA  to  observe, 
what  it  has  repeatedly  happened  to  me  to  see:  that  almost  all 
patients  on  ship-board,  labouring  under  obstinate  chronick 
complaints,  which  could  in  no  way  be  managed  or  subdued 
in  port,  are  cured  spontaneously  after  a  voyage  of  a  week  or 
two;  especially  if  the  vessel  should  have  sailed  from  a  port 
open  to  turbulent  winds  and  intemperate  weather,  to  a  milder 
climate:  or  to  another  place,  screened  from  the  piercing 
blasts  that  sweep  away  the  unfortunate  victims  of  breast 
complaints,  from  the  sick-bays  of  our  ships  during  the  win- 
ler  season. 


20 

offer  some  remarks  respecting  the  manner  in  which 
the  climate  of  this  country,  in  particular,  injures  the 
constitution. 

Observations  hav^  clearly  ascertained  that  coun- 
tries which  enjoy  a  moderate,  mild,  and  equable  cli- 
mate, are  the  most  salubrious;  and  those  that  are  hot, 
cold,  or  humid,  the  most  pernicious  to  health,  espe- 
cially if  they  should  be  subject  to  sudden  vicissitudes 
of  the  weather.  Celsus  long  since  remarked,  that 
countries  equably  warm,  or  uniformly  cold:  and  such 
seasons  of  the  year  as  are  remarkable  for  a  like  uni- 
formity in  heat  or  coldness,  are  the  most  favourable 
to  health;  whilst  those  on  the  other  hand,  characte- 
rized by  excessive  variableness,  are  highly  injurious. 
The  truth  of  this  observation  is  evidenced  in  the 
island  of  Great  Britain,  where  the  air  during  the  four 
or  five  summer  months  is  moderate  and  generally 
bland,  dry,  and  equable;  hence  during  this  period  it 
is  universally  agreeable  and  salubrious;  all  the  re- 
maining part  of  the  year,  however,  it  is  cold,  humid, 
and  variable;  and  consequently  productive  of  exces- 
sive unhealthiness.^ 

«  The  climate  of  Great  Britain  is  a  peculiar  one,  and  the 
state  of  the  air  variable  in  the  extreme.  A  momentary  glance 


21 

Physiology  teaches  us,  that  a  due  motion  and  cir- 
culation of  the  fluids  throughout  the  whole  system, 
are  necessary  to  ensure  the  health  of  every  part. 
Whatever  therefore  has  a  tendency  to  impede  this 
healthy  action,  will  accordingly  derange  the  system. 

at  its  geographical  situation,  will  explain  the  cause  of  this 
versatility  of  the  weather,  as  well  as  of  the  turbulence  of  the 
prevailing  winds  throughout  the  year:  and  the  almost  con- 
stant haziness  of  the  atmosphere  during  the  winter,  autumn 
and  spring  months.  Being  an  island  pretty  far  north,  and  not 
any  part  of  it  being  much  more  than  sixty  miles  from  the 
sea,  the  air  is  generally  cold  and  moist,  and  though  the  sea 
air  itself  from  its  moisture,  has  no  unhealthful  effect  on  the 
constitution  even  of  a  valetudinarian,  yet  it  has  always  been 
remarked  that  places  lying  immediately  in  the  face  of  its  in- 
fluence, are  rendered  unhealthy  by  it.  Hence  it  would  seem 
that  the  insalubrity  of  the  air  in  the  vicinity  of  the  sea  is  de- 
rived from  some  adventitious  quality  which  it  somehow  re- 
ceives in  its  passage  over  the  land.  We  may  form  some 
idea  of  the  degree  of  moisture  the  atmosphere  of  an  island 
like  Great  Britain,  surrounded  by  the  sea,  must  be  endued 
with,  when  it  is  computed  that  from  the  Mediterranean 
Sea  only,  5280  millions  of  tons  of  vapour  rise  in  a  summer 
day;  it  is  true  the  evaporating  causes  are  not  so  powerful  in 
the  sea  surrounding  Great  Britain;  but  yet  the  moisture 
must  be  considerable.  In  Great  Britain  the  winds  two-thirds 
of  the  year  are  in  the  southerly  and  westerly  quarters. 

Dr. 


Now,  cold  air,  especially  if  it  be  humid,  has  a  power- 
ful effect  in  checking  perspiration  and  in  impeding 

Dr.  Campbell,  in  Lancaster,  (England,)  in  the  course  af 
seven  years  found  the  winds  to  be  in  this  proportion: 

Westerly,         216  days  in  the  year. 
Easterly,  1 49 

The  direction  of  the  winds  was  observed  at  Dover  for 
three  years,  and  they  were 

Westerly,         321 
Easterly,  173 

In  the  city  of  Edinburgh  the  winds  were  observed  to  blow 
as  follows: 

Anno  1797.  West  256  days — East  109  days. 
1798.  West  250  days— East  115  days. 
Vide  Transactions  Roy.  Soc.  Edin. 

There  is  some  similarity  between  the  climate  of  England 
and  the  United  States  during  the  spring  and  winter  seasons. 
The  sudden  transitions  of  the  weather  from  the  extremes  of 
heat  to  cold,  and  vice  versa,  are  as  remarkable  here  as  in 
Great  Britain:  and  from  actual  observation  I  have  found  that 
the  effects  of  these  vicissitudes  on  valetudinarians  on  ship- 
board, are  singularly  similar  and  fatal,  in  both  countries. 
There  is  this  difference  however  in  the  relative  state  of  the 


23 

the  circulation  of  the  blood  through  the  external 
parts  of  the  body.  For  the  external  application  of 

atmosphere,  that  in  England  it  is  always  more  humid,  espe- 
cially during  the  winter  time,  a  circumstance  undoubtedly 
owing  to  the  vicinity  of  the  sea.  And  though  in  the  interiour 
of  our  country,  and  in  the  Atlantic  states,  at  the  distance  of 
eighty  or  an  hundred  miles  from  the  ocean,  the  air  is  gene- 
rally dry;  yet  in  the  tracts  of  country  lying  immediately  on 
the  sea-board,  it  is  marked  by  the  same  humidity  as  that  of 
England.  Whether  the  state  of  the  atmosphere  in  the  United 
States  is  actually  purer  than  that  of  Great  Britain,  is,  I  think, 
problematical,  although  Dr.  Williamson  leans  to  the  opinion 
that  the  air  of  America  is  more  pure  than  that  of  the  coun- 
tries of  Europe.  This  he  infers  from  the  circumstance  of  our 
repeated  and  successive  clear  blue  skies,  which  may  be  ob- 
served night  after  night  in  the  United  States,  adorned  by 
countless  stars;  and  these  he  remarks  are  seldom  equalled 
in  those  parts  of  Europe  frequented  by  travellers.  (See 
his  Essay  on  the  Climate  of  America,  Sec,  page  175.)  From 
this  similarity  of  climate  we  may  naturally  expect  that 
the  diseases  of  this  country  will  also  be  allied,  and  accord- 
ingly we  find  consumption  and  affections  of  the  breast,  very 
common  in  the  eastern  states.  Hence  we  may  infer  that  in 
cases  similar  to  those  for  which  Dr.  Gregory  recommends 
a  voyage  to  a  milder  climate,  much  advantage  may  be  de- 
riyed  from  travelling,  either  hy  land,  or  by  sea,  from  the 
northern  and  middle  states  to  those  of  Carolina  and  Georgia. 


24 

of  cold  constricts  the  vessels  and  pores  of  the  skin, 
while  excessive  moisture  relaxes  the  muscular  fibres, 
weakens  the  contractile  powers  of  the  heart,  and  cer- 
tainly diminishes  the  action  of  the  arteries.  The 
blood,  consequently,  is  not  propelled  to  the  external 
parts  of  the  body  with  due  force.  Whether  this  how- 
ever be  the  cause  of  the  diminution,  or  whether  it 
arises  from  other  sources,  it  is  unquestionable,  that 
the  perspiration  is  very  considerably  diminished  dur- 
ing the  prevalence  of  cold  or  moisture. 

The  most  imminent  danger,  however,  arises  from 
the  sudden  changes  of  the  weather,  which  occur  so 
frequently,  nay,  we  might  almost  say  daily,  in  this 
island.^  It  is  by  the  effect  of  these  transitions,  that 

3  Whether  this  inconstant  state  of  the  air  has  really  a 
prejudicial  influence  on  the  corporeal  strength  and  health, 
seems  to  be  doubted  by  highly  respectable  authorities.  We 
are  told,  by  Dr.  Rush,  in  his  account  of  the  climate  of  Penn- 
sylvania, that  "  its  variable  nature  does  not  render  it  neces- 
sarily unhealthy."  In  substantiation  of  this  opinion,  he  quotes 
Dr.  Huxham,  who  has,  he  says,  "  taught  us  that  the  healthi- 
est seasons  in  Great  Britain  have  often  been  accompanied 
by  the  most  variable  vreather.  His  words,'*  continues  Dr. 
Rush,  "  convey  a  reason  for  the  fact."  <  When  the  constit«- 


25 

the  circulation  of  the  fluids  is  most  disturbed;  for 
when  the  external  surface  of  the  body  becomes  sud- 
denly chilled,  and  the  extreme  vessels  consequently 
constricted,  the  blood  flowing  freely  and  4irectly  to 

tions  of  the  year  are  frequently  changing,  so  that  by  the  con- 
frast  a  sort  of  equilibrium  is  kept  up,  and  health  with  it;  ^nd 
that,  especially  if  persons  are  careful  to  guard  themselves 
well  against  these  sudden  changes.'  f  Huxham'sObservations 
on  the  Air  and  Epidemic  Diseases,  Vol.  I.  p.  5.]'*  Whatever 
be  the  physical  operation  of  these  vicissitudes  on  the  body, 
on  land,  it  is  very  certain  that  their  eifects  at  sea  on  the  sys- 
tem, are  neither  trifling  nor  salutary;  for  I  have  never  failed 
to  remark,  during  my  practice  in  the  navy,  that  sailors  al- 
ways suffered  more  or  less  from  the  sudden  transitions  of 
the  weather.  I  must  not  omit  to  mention,  however,  that 
these  effects  of  the  quick  changes  of  the  weather,  were  sel- 
dom so  frequent  among  the  officers,  and  other  persons  on 
board,  however  great  their  exposure  might  be,  who  took 
more  precautions  to  guard  against  danger  than  the  impro- 
vident sailor  can  ever  be  brought  to  do.  One  thing  is  certain, 
that  the  changes  of  the  weather  in  a  climate  where  heat  and 
cold  prevail  alternately,  to  a  great  degree,  during  the  differ- 
ent seasons  of  the  year,  have  no  little  influence  on  the  moral 
state  of  the  system.  "  The  eifects  of  a  climate  of  this  kind," 
says  Dr.  Falconer,*  «  have  not,  as  far  as  I  know,  been  re- 

*  Remarks  on  the  influence  of  Climate,  &c.  on  the  Disposition,  Manners, 
&c.  &c.  of  Mankind,  4to,  p.  24. 

D 


'       26 

the  superficial  parts  is  checked,  and  impelled  imme- 
diately from  them,  inwardly,  producing  a  copious 
and  violent  regurgitation.  In  like  manner,  when  the 
invisible  (;utaneous  pores  are  clogged  up,  the  perspi- 
ration is  checked;  and  this  is  undoubtedly  the  most 
indispensable  of  all  the  excretions.  These  are  the 
causes  that  produce  internal  congestion  of  the  blood, 
which  is  frequently  followed  by  inflammations  and 
hemorrhages;  they  likewise  engender  fevers,  and  a 

marked  by  any  modern  writers,  but  did  not  escape  the  ob- 
servation of  Hippocrates;  though  the  countries  he  seems  to 
rank  in  this  class  are,  indeed,  such  as  undergo  considerable 
varieties  in  temperature  at  the  different  seasons;  many  parts 
of  Europe  for  instance;  but  are  still  what  are  at  present  es- 
teemed to  be  in  a  moderate  climate,  and  by  no  means  sub- 
ject to  such  vicissitudes  as  a  great  part  of  North  America, 
and  that  vast  continent  between  Asia  and  Europe,  called  Si- 
beria and  Tartary.  Hippocrates  observes,  (Hippocrates  de 
aeribus,  aquis,  et  locis,  §  39.  53,  54,  55.)  that  in  such  a  cli- 
mate, the  shape  and  character  of  the  people  are  much  less 
uniform,  than  in  either  a  hot  or  cold  country.  This  appears 
very  probable,  as  the  climate  partakes  of  the  extremes  of 
both.  He  also  thinks,  that  '  variations  of  climate  make  men 
more  active  in  the  affairs  of  life,  more  brave  and  resolute  in 
their  conduct,  and  more  austere  and  rugged,  though  more 
upright  and  just  in  their  behaviour.'  " 


27 

great  many  other  diseases.  It  is  not  surprising,  there- 
fore, that  our  climate  should  be  productive  of  a  va- 
riety of  dangerous  maladies,  nor  that  persons  of  the 
strongest  constitutions  should  be  afflicted  with  se- 
rious disorders.  Generally,  however,  with  the  assist- 
ance of  nature,  we  can  easily  guard,  in  healthy  and 
vigorous  temperaments,  against  every  danger  accru- 
ing from  the  climate,  so  that  no  disease  will  ensue 
from  its  effects,  and  even  should  any  disorder  affect 
the  system,  it  will  be  of  short  duration. 

In  many  cases  of  dangerous  disease,  nature  her- 
self^ as  every  physician  knows,  spontaneously  affords 
the  best  remedy;  and  she  certainly  prevents  by  her 
powers,  the  accession, — or  banishes  when  they  may 
have  arisen — innumerable  disorders  that  could  scarce- 
ly be  cured  by  any  other  means.  This  happens  in  the 
case  under  our  consideration  at  this  moment,  for  as 
soon  as  the  impetus  of  blood  to  the  external  parts  is 
checked  by  the  operation  of  cold,  the  action  of  the 
heart  and  arteries  is  simultaneously  increased,  and 
the  pulse  augmented  in  frequency  and  force.  In  con- 
sequence of  this  increase  in  the  contractions  and  di- 
latations of  the  heart,  the  constriction  of  the  extreme 
vessels  which  impeded  the  natural  motion  of  the 


2» 

blood  is  soon  overcome  and  entirely  removed;  hence 
the  customary  distribution  of  the  fluids,  and  the 
wonted  equilibrium  of  the  circulation  are  perfectly 
restored.  But  if  the  constitution  shall  have  previously 
become  feeble  and  enervated,  or  predisposed  to  any 
disease,  it  will  not  be  able  to  bear  the  same  unsea- 
sonable transitions  of  climate  without  injury.  The 
vires  medicatr ices  naturae ^  which,  under  more  pro- 
pitious circumstances,  guarded  the  system  against 
danger,  and  restored  it  from  disease  to  health,  are 
inefficient  here.  And  it  is  very  probable,  that  some 
particular  part  of  the  body  which  may  have  been  pre- 
viously weakened  or  disordered,  and  which,  conse- 
quently, has  become  incapable  of  sustaining  the 
shock, — will  be  rendered  the  subject  of  an  incurable 
malady. 

Thus  it  is,  that  the  human  constitution,  provided 
indeed  it  be  vigorous  and  sound,  accommodates  it- 
self so  surprisingly  to  all  variations  of  climate,  from 
the  coldest  to  the  temperate,  and  the  more  fervid; 
that  for  the  most  part  it  suffers  no  injury  from  their 
diverse  temperatures.'*  Cold  and  moist  air,  such  as 

*•  "  Perhaps  no  climate  or  country  is  unhealthy,  where 
men  acquire  from  experience,  or  tradition,  the  arts  of  ac- 


29 

prevails  in  treat  Britain,  is  the  least  favourable  to 
perspiration,  and  an  equable  distribution  of  the  fluids; 
but  nature  has  so  amply  provided  for  that  inconve- 
nience, that  the  natural  circulation  of  the  fluids,  in  so 
far  as  is  essential  to  health,  is  sufiiciently  promoted: 
consequently,  those  who  are  blest  with  sound  and 
robust  constitutions,   suffer   little  or   no  detriment 
from  this  cause.  Yet  we  see,  notwithstanding,  many 
instances,  in  which  the  healthiest  temperament  af- 
fords no  barrier  to  the  hurtful  incursions  of  the  cli- 
mate of  this  country.  It  is  probable,  that  there  are 
critical  and  dangerous  periods  in  some  constitutions, 
and  without  doubt  there  are  idiosyncracies  arising 
from  peculiarities  in  the  manner  of  living,  as  well  as 
from  the  various  conditions  of  men,  and  from  other 
causes  not  accurately  investigated,  which  render  per- 
sons who  are  in  other  respects  perfectly  vigorous, 
liable  to  diseases  incidental  to  climate.  It  should  be 
remarked,  however,  that  although  the  irregular  and 
Unseasonable  variations  of  the  weather,  do  certainly 

commodating  themseh^es  to  it.  The  history  of  all  the  nations 
of  the  world,  whether  savage,  barbarous,  or  civilized,  pre- 
vious to  a  mixture  of  their  manners  by  an  intercourse  witK 
strangers,  seems  to  favour  tins  opinion." — Rush  on  the  Cli- 
mate of  Pennsijlvania. 


30 

exert  most  powerful  effects  on  the  consiitution,  and 
tend  to  produce  many  serious  disorders;  yet  it  hap- 
pens, not  unfrequently,  that  evils  are  imputed  to  the 
influence  of  chmate,  which  in  fact  it  has  but  little 
agency  in  generating;  and  which  really  derive  their 
origin  altogether  from  other  sources.  For  in  every 
clime,  however  variable  and  insalubrious  it  may 
be,  we  find  inhabitants  enjoying  perfect  health;  and 
no  portion  of  the  terraqueous  globe  gives  birth  to 
any  race  of  beings,  that  are  liable  to  be  annihila- 
ted by  the  destructive  effects  of  the  climate  they  in- 
habit. It  has  not  ever  been  observed  either,  that  other 
animals  are  injured  by  the  influence  of  their  native 
clime,  however  insalubrious  and  intemperate  it  may 
be,  and  even  under  circumstances  of  the  greatest  pos- 
sible exposure  to  the  power  of  its  severity.  We  surely 
cannot  doubt  then,  that  men  may  be  able  to  endure 
the  irreguiar  transitions  of  climate  without  either  in- 
jury or  danger,  provided  they  live  temperately.  Nor 
can  we  for  a  moment  beUeve,  as  we  should  by  ad- 
mitting a  contrary  position  to  be  true:  that  the  creator 
and  preserver  of  the  human  race  would  subject  man- 
kind to  a  condition  so  rigorous  and  unjust.  Besides, 
those  men  who  are  accustomed  to  a  rude,  and  labo- 


31 

l-ious  life,  who  are  but  little  regardful  of  the  u'nsea- 
sonableness  of  the  weather,  to  the  vicissitudes  of 
which  they  are  continually  exposing  themselves,  cer- 
tainly live  in  the  enjoyment  of  health  and  vigour 
like  other  animals;  nor  was  it  till  he  discovered  and 
brought  to  perfection,  artificial  means  of  defending 
the  body  generally,  from  the  extremities  of  the  sea- 
sons, that  man  was  subdued  by  the  severity  of  his 
native  cHme.  Those,  therefore,  who  are  unskilled  in 
the  means  of  avoiding  or  guarding  against  tlie  extre- 
mities of  weather,  seldom  suffer  any  inconvenience 
from  it;  and  it  is  only  in  proportion  as  men  become 
afraid  of  exposing  themselves  to  the  intemperance  of 
the  air,  and  sedulously  endeavour  to  avoid  it — that 
they  are  rendered   very  susceptible   of  its  effects. 
There  is  certainly  but  one  method,  by  which  men 
are  enabled  to  defend  themselves  against  the  rigour 
of  an  unhealthy  climate;  namely,  by  rendering  their 
constitutions  so  vigorous  and  robust,  that  they  are 
in  a  situation  to  encounter  and  endure,  the  danger 
and  inconvenience  they  cannot  shun.  It  is  not  sur- 
prising therefore,  that  those  who  are  accustomed  to 
polished  life,  and  to  indulgence  in  various  luxuries, 
should  be  solicitous  to  elude  the  rigorous  excesses 
of  the  weather.  For  if,  from  the  causes  we  have  men- 


32 

tioned,  we  find  that  men  in  other  respects  very  ro- 
bust, and  in  the  full  enjoyment  of  perfect  health,  can 
scarcely  endure  this  severity  without  annoyance; 
how  much  danger  is  not  to  be  dreaded  for  those 
who  have  inherited  from  nature,  less  healthy  consti- 
tutions— who,  from  living  intemperately,  or  other- 
wise unhealthfully,  have  rendered  their  systems  sub- 
ject to  various  disorders — who  from  ill  health,  or  from 
whatever  cause  are  broken  down  and  exhausted  in 
strength — or  finally,  for  those  advanced  in  years,  or 
continually  inclined  to  depression  of  spirits,  and  in 
whom  all  the  natural  powers  of  the  mind  and  the 
body  are  wasting  away  by  degrees! 

It  is  in  cases  then  of  this  nature,  that  we  should 
seek  another  climate  blest  with  the  cheering  aspect 
of  a  clear  and  serene  sky,  assisted  in  its  happy  effect 
upon  the  feelings  by  the  genial  influence  of  soft 
breathing  zephyrs.  Where  the  prevalence  of  pleasant 
and  more  agreeable  manners  and  livelier  scenes  are 
calculated  to  soothe  the  feelings,  to  promote  cheer- 
fulness, and  to  revive  the  declining  powers  of  na- 
ture.* But  let  us  pass  on  to  the  consideration  of  other 

^  Dr.  Cheyne  in  his  most  excellent  work,  on  health  and 
long  life,  tells  us  with  singular  brevity  and  quaintness,  that 


33 

arguments  tending  to  prove  the  efficacy  of  a  change 
of  climate  in  many  diseases. 

How  limited  is  human  knowledge!  How  rarely 
does  it  scrutinize  the  unerring  and  indispensable 
causes  of  things!  Even  on  our  art,  the  light  of  sci- 
ence has,  as  yet,  but  coruscated!  For  as  yet  the  na- 
ture of  many  diseases,  as  well  as  their  remote  and 
proximate  causes,  are  either  totally  unknown  to  us, 
or  at  least  but  imperfectly  comprehended.  When- 
ever, therefore,  we  observe  a  disease  endemial  to  any 
country,  which  seldom  occurs  under  another  sun, 
it  is  highly  probable  that  this  disorder  is  caused  by 

"  if  the  aged  would  lengthen  out  their  days,  they  should  re- 
move to  a  warmer  climate,  by  which  they  may  live  as  long 
as  a  croiv!^* — London  edition  of  1725,  page  206. 

We  are  told  too,  that  "  the  citizens  of  Rome  who  had  worn 
down  jtheJr  constitutions  by  intemperance,  addedjmany  years 
to  their  lives,  by  migrating  to  Naples,  and  enjoying  there, 
in  a  warmer  sun,  the  pure  air  of  the  Mediterranean.  And  Sir 
William  Temple  says  the  Portuguese  obtain  the  same  be- 
nefit by  transporting  themselves  to  the  Brasils,  after  medi- 
cine and  diet  cease  to  impart  vigour  to  their  constitutions  in 
their  native  country."— i?wsA*5  Obser,  on  Gout.  Inquiries^ 
Vol.  II.  p.  319. 

E 


34 

the  influence  of  climate,  and  we  may  reasonably  ex- 
pect that  the  patient  labouring  under  such  complaint 
will  be  benefited  by  travelling  into  a  country  ex- 
empt from  the  same  disorder.  And  from  the  want  of 
other  and  more  certain  sources  of  reasoning,  I  have 
supposed  that  an  argument  in  favour  of  my  opinion, 
might  be  deduced  from  this  principle,  and  though 
indeed  it  is  an  uncertain  one,  yet  I  cannot  think  it 
altogether  contemptible. 

In  many  diseases  indeed,  the  proximate  causes  of 
which  we  are  acquainted  with — the  curative  indica- 
tion consists  in  promoting  the  perspiration,  and  re- 
storing  the  due  circulation  of  the  blood  to  the  ex- 
ternal surface  of  the  body,  so  that  an  excessive 
determination  to  the  internal  parts  may  be  prevent- 
ed; or,  if  it  shall  have  already  taken  place,  that  it 
may  be  immediately  removed.  Now  I  do  not  know 
of  any  remedy  by  which  all  these  objects  can  be 
more  speedily,  more  safely,  or  more  agreeably  ac- 
complished, than  by  a  change  of  climate;  and  this 
change  must  be  effected  by  means  of  a  journey  into 
a  country  enjoying  a  moderate  degree  of  warmth.  A 
new  climate  is  preferable  as  a  remedy,  to  every  thing 
else,  because  the  patient  can  derive  the  benefit  of  it 


^5 

not  only  for  a  few  hours  together,  but  for  many 
months,  nay,  should  it  be  necessary — for  many 
years;  and  it  is  well  known  to  physicians  that  many 
of  those  diseases  which  are  denominated  chronick, 
are  so  obstinate  and  difficult  of  cure,  that  a  great 
length  of  time  is  required  to  subdue  and  remove 
them,  even  when  the  best  and  most  efficacious  me- 
dicines are  daily  employed;  nor  are  they  unacquaint- 
ed with  the  fact,  that  many  medicines  which  act  with 
great  power  on  the  system,  will  not  bear  to  be  fre- 
quently repeated  for  any  length  of  time.  The  con- 
tinual exhibition  of  such  active  medicines  for  a  long 
while  injures  the  constitution,  and  in  fact  induces 
new  disorders.  Some,  by  continued  use,  lose  their 
pristine  virtues,  and  then  consequently  they  produce 
no  beneficial  effect  on  the  system;  others,  though 
safe  and  efficacious,  become  by  long  repetition  so 
extremely  unpleasant  and  ungrateful  to  the  sick,  that 
rarely  is  a  patient  \Yilling  to  persist  in  their  use  suf- 
ficiently long  to  receive  any  benefit.  But  this  remedy 
may  be  continued  for  a  considerable  time,  not  only 
without  danger,  but  actually  with  the  greatest  ad- 
vantage! It  neither  injures  tlie  constitution — nor  loses 
its  virtues  by  repetition — nor  does  it  become  un- 
pleasant to  the  sick!  It  is  on  thq^  contrary,  for  various 


36 

reasons,  truly  grateful.  Neither  does  it  debilitate  the 
system,  but,  for  the  most  part,  greatly  strengthens  it. 
And  lastly,  if  a  change  of  climate  is  not  of  itself  suf- 
ficient to  remove  the  disorder,  we  should  seek  the 
adventitious  aid  of  all  the  other  remedies  which  have 
been  useful  at  home.  For  all  things  are  to  be  found 
in  a  happier  clime,  and  they  are  often  rendered  more 
efficacious  under  the  genial  influence  of  a  foreign 
sun. 

But  there  are  some  maladies,  whose  proximate 
causes,  if  they  be  not  altogether  hidden  from  our 
view,  are  at  least  veiled  in  uncertainty:  while  their 
remote,  predisposing  and  occasional  causes  are  suffi- 
ciently obvious.  And  it  is  evident  to  the  observation 
of  medical  men,  that  the  remote  predisposing  and  ex- 
citing causes  of  many  diseases,  ai:ise  from  the  influ- 
ence of  our  climate.  That  is  to  say,  in  the  colder  coun- 
tries you  will  find  a  certain  tendency  to  inflamma- 
tion in  diseases,  usually  denominated  phlogistic  dia- 
thesis, prevailing  almost  universally  among  the  in- 
habitants, especially  during  the  winter  and  in  the 
spring.  But  in  warmer  countries,  as  is  the  case  also 
with  us  in  the  summer  season,  this  inflammatory  dis- 
position is  not  so  common.  Hence  we  may  reasona- 


37 

bly  expect,  that  this  disposition,  whatever  it  may  be, 
will  either  be  entirely  obliterated  by  a  change  of  cli- 
mate, or  at  least  that  it  will  be  greatly  mitigated. 

In  cold  countries  too,  especially  in  those  where  a 
cloudy,  moist  and  gloomy  atmosphere  depresses  the 
spirits,  all  the  faculties  of  the  mind,  as  well  as  the 
powers  of  the  body,  grow  feeble  and  enervated.^  The 
system  becomes  weak,  languid  and  inactive,  while  the 
spirits  grow  dull,  dejected  and  apathetick,  of  course 
the  disposition  is  inclined  rather  to  melancholy  than 

*  This  position  in,  I  think,  questionable;  and  that  it  is  so 
may  be  inferred  from  an  attentive  consideration  of  the  direct 
action  of  cold  upon  the  body,  and  its  indirect  effect  upon  the 
mind  and  disposition.  The  indirect  action  of  external  or  ai- 
mospherick  cold  on  the  mind  and  feelings,  is  produced 
through  the  influence  of  its  immediate  effects  on  the  corpo- 
real system.  These  effects  are  palpable  to  the  senses,  and 
simultaneous  with  the  application  of  this  powerful  agent  to 
the  external  surface  of  the  body.  Cold  evidently  blunts  the 
acuteness  of  feeling;  and  this  it  does  by  so  wrinkling  the 
skin,  that  the  cutaneous  pores  are  corrugated  and  contract- 
ed in  diameter.  It  operates  also  upon  the  cutaneous  glands, 
by  closing-^or  clogging  up  their  orifices,  so  that  the  free  ad- 
mission of  the  irritating  matter  which  in  this  or  some  other 
way,  causes  sensation,  is  prevented.  Hence  the  intensity  of 
•  utaneous  feeling,  is  considerably  diminished.  The  external 


38 

cheerfulness.  Hence  is  produced,  as  I  shall  after- 
wards have   occasion  to  show,   a   tendency  in  the 

action  of  cold  on  the  skin  diminishes  the  quantity  of  perspi- 
ration. It  also  aflPects  its  tenuity,  rendering  it  thick  and  more 
viscid.  These  combined  effects  produce  a  powerful  influence 
on  the  mind,  rendering  it  less  sensible  of  the  external  im- 
pressions on  the  body;  and  by  thus  blunting  the  power  of 
feeling,  it  renders  the  general  system  more  insensible.  The 
physiological  operation  of  cold  on  the  mind,  and  conse- 
quently its  effects  upon  the  temper,  the  disposition,  and  the 
feelings,  cannot  appear  ambiguous,  when  we  advert  to  its 
evident  effects  on  the  body  as  just  described.  That  the  cha- 
racter would  in  some  measure  be  affected  by  these  causes, 
seems  natural  to  suppose.  Accordingly  it  has  been  deci- 
sively asserted,  and  I  believe  with  no  little  truth,  that  the 
inhabitants  of  cold  countries  are  not  subject  to  those  violent 
vicissitudes  of  temper  and  that  versatility  of  disposition, 
which  characterize  those  of  hot  climates,  where  the  highly 
excited  sensibility  of  the  system,  and  the  almost  morbid  ten- 
derness of  feeling,  render  the  people  susceptible  of  every 
varying  impression  to  which  the  constitution  is  physically 
exposed.  Hence  the  disposition  of  the  inhabitants  of  cold 
countries,  is  more  faithful,  immutable  and  brave,  and  the 
behaviour  more  consistent,  than  that  of  people  dwelling 
under  the  enervating  influence  of  a  fervid  sun,  and  ever 
liable  to  the  vascillancy  of  a  mutable  and  capricious  cli- 
mate. Though  these  peculiarities  in  the  constitutional  tem- 


39 

system  to  be  affected  by  certain  diseases.  Now  it 
is  universally  known  that  the  case  is  exceedingly  dif- 

per  of  the  inhabitants  of  cold  countries,  are  generally  as- 
cribed, exclusively  to  the  positive  and  direct  action  of  the 
frigid  air:  yet  it  must  not  be  forgotten  that  there  ate  other 
causes  indirectly  generated  by  the  coldness  of  the  climate, 
and  some  that  are  wholly  independent  of  any  such  influ- 
ence— ^that  have  no  little  agency  in  assisting  and  confirming 
the  eff'ects  of  air  upon  the  physical  and  moral  constitutions: 
such  for  example  are  food,  clothing  and  exercise;  as  well  as 
religion,  government  and  laws.  But  even  allowing  for  the 
adventitious  aid  of  all  these  causes,  the  dominion  of  the 
effects  of  climate  over  the  form,  stature,  and  health  of  the 
body,  is  active,  evident,  unequivocal.  Some  writers,  however, 
have  leapt  beyond  the  possible  effect  of  the  causes  which 
are  derived  from  climate,  in  the  overstrained  hypotheses 
they  have  promulgated,  and  which  they  have  predicated  on 
the  physical  and  moral  influence  of  climate  on  the  human 
subject.  In  these  ingenious  though  sometimes  crude,  un- 
philosophick,  and  not  unfrequently  chimerical  theories, 
which  indeed  ought  only  to  be  viewed  as  the  effusions  of 
vivid  and  fanciful  minds,  they  have  not  hesitated  to  refer  all 
the  variations  in  human  constitution,  form,  stature  and  com- 
plexion: as  well  as  all  the  inflections  of  the  variable,  nay, 
even  changing  human  character;  together  with  all  the  grades 
in  morals,  from  the  turpitude  of  vice  to  the  beauty  of  virtue 
— to  the  effect  of  climate  alone!  While  this  subject  is  before 


40 

fercnt  in  countries  moderately  warm,  dry  and  clear; 
for  the  inhabitants,  at  least  generally,  possess  great 
activity  of  body,  and  enjoy  an  equable  flow  of  spi- 

"me,  I  cannot  refrain  from  quoting  a  passage  from  the  inge- 
nious and  learned  inaugural  dissertation  of  my  friend  Dr. 
Gibson,  now  Professor  of  Surgery  in  the  Baltimore  Col- 
lege of  Medicine.  Its  pertinency  to  the  subject  of  the  pre- 
ceding remarks,  is,  I  trust,  a  sufficient  excuse  for  the  cita- 
tion: 

"  Praeter  diaetam  et  artificium,  sunt  et  aliae  causae  quae  ad 
figuram  corporis  humani  mutandam  aliquantulum  conferre 
possunt:  hue  spectant  imitatio,  varia  exercitationis  genera, 
vestimenta,  scientia,  religio,  animi  pathemata,  coelum,  et 
quaedam  alia.  Non  forsan  alienum  erit  pauca  de  coeli  effec- 
tibus  monere,  etsi  meo  quidem  judicio,  in  mutationibus  fi- 
gurae  animantium  inducendis  multo  minus  valet,  quam  non- 
nullis  persuasum  est.  Dicitur  staturam  admodum  humilem 
Indorum  Eskimotarum,  et  quarundam  aliarum  gentium  sep- 
tentrionalium  deberl  frigori  maxime  intenso,  cui  perpetue 
objiciuntur  in  iis  regionibus  quas  ibcolunt.  Tschutski  tamen 
in  terrae  plaga  aeque  frigida  saltern,  si  non  revera  frigidiorc, 
degunt,  nihilominus  inter  homines  procerissimos  jure  re- 
censentur.  Minutam  Eskimotarum  staturam  e  genere  cibi 
potissimum  pendere  colligerem,  oleo  enim  Phocae  Vitulinae, 
et  Phocaenae  maxime  aluntur.*  Hippocrates  cceli  regionem 

*  Ellis' Voyage,  &c. 


4t 

rits.  It  is  not  difficult  to  believe  then,  that  travelling 
in  such  countries  would  greatly  correct  and  improve 
the  gloomy  disposition  of  which  we  have  just  spoken, 
and  perhaps  banish  it  entirely.  There  is  another  ad- 
vantage that  we  certainly  derive  from  a  change  of 
climate,  and  it  is  one  of  great  importance,  namely, 
guarding  against  the  occasional  causes  of  many  dis- 
eases. It  is  generally  known  that  many  severe  dis- 
orders generated  in  this  island,  originate  in  the  sud- 

in  figura  mutanda  non  parum  valuisse  opinatur,  sic  enim 
pergit,  *  Quicunque  autcm  altam  habitant  regioncm,  planam, 
ventis  expositam  et  aquosam,  eorum  formse  magnae  ac  invi- 
cem  similes  et  erectse.  Qui  vero  macra,  aquis  carentia,  et 
nuda  loca  tenent,  horum  formas  necisse  est  esse  asperas  et 
vegetas.'*  "  Vitruvius  qiioque  huic  sententise  addictus  est, 
verba  ejus  citare  liceat,"  '  Ex  roscido  sere  sub  septentrioni- 
bus  nutriuntur  gentes  immanibus  corporibus,  candidis  colo- 
ribus,  directo  capillo  et  rufo,  oculis  caesiis,  sanguine 
multo,  quoniam  ab  humoris  plenitate,  coeli  refrigerationibus 
sunt  conformati.  Qui  autem  sunt  proximi  ad  axem  meri- 
dianum,  subjectique  solis  cursui,  brevioribus  corporibus, 
colore  fusco,  crispo  capillo,  oculis  nigris,  cruribus  invali- 
dis,  sanguine  exiguo,  solis  impetu  perficiuntur/f — Bisser- 
tatio  Physica  de  Forma  Ossium  Gentilitia^  auctore  Gulielmo 
Gibson,  p.  92. 

*  De  iEre,  Aqua,  et  Locis.  f  Vitruvius  de  Architectura,  torn.  yi. 


42  .     . 

den  changes  of  the  weather;  and  the  danger  arising 
from  this  source  is  scarcely  evitable  any  other  way 
than  by  travelling  into  temperate  countries,  where 
the  weather,  even  of  the  winter  season,  is  not  at  all 
liable  to  such  sudden  transitions.  It  follows  therefore, 
that  all  the  remote  causes  of  such  diseases  as  arise 
from  the  effects  of  our  climate,  may  be  avoided  or 
abated  in  their  pernicious  effects  by  a  change  of  air; 
and  we  all  know  of  how  much  importance  it  is  in  the 
cure,  we  might  almost  say,  of  every  malady,  that 
these  causes  should  be  quickly  removed/  A  disorder 

"f  A  striking  instance  of  the  efficacy  of  removing  patients 
from  the  place  where  the  disease  is  produced,  is  related  by 
Mr.  Volney.  It  goes  far  to  prove,  tlmt  sometimes  a  very 
circumscribed  space  is  within  sphere  of  the  action  of  the 
remote  causes  of  a  disease,  and  consequently  that  a  removal 
of  the  patient  to  a  little  distance  only,  from  this  local  influ- 
ence, may  oftentimes  have  a  very  beneficial  effect.  I  will 
cite  the  passage  in  his  own  words:  "  In  Corsica,  fevers  of 
the  same  kind  regularly  annoy  several  military  posts  in  the 
island  every  year,  and  among  others  the  little  harbour  of 
San  Fiorenzo,  bordering  on  a  pestilential  marsh  of  forty-five 
acres.  Toward  the  end  of  summer,  and  in  the  first  six  weeks 
of  autumn,  they  assume  a  putrid  and  malignant  character, 
in  consequence  of  the  intensity  of  the  heat  and  the  exhala- 
tion; and  it  is  necessary  to  relieve  the  French  garrisons 


43 

frequently  meets  with  a  speedy  cure  after  the  removal 
of  its  remote  causes,  without  the  administration  of 

every  fifteen  or  twenty  days,  either  wholly  or  in  part,  other- 
wise the  soldiers  would  sink  under  their  serious  and  ulti- 
mately mortal  effects.  Our  physicians,  after  trying  many  re- 
medies, remarked,  that  two  posts  alone  in  the  whole  island 
were  absolutely  exempt,  and  that  no  fever  ever  approached 
forts  Vivario  and  Vitzavona  on  Bogognano.  Chance,  as  fre- 
quently happens,  rendered  the  salubrious  and  even  curative 
quality  of  these  two  situations  more  striking.  A  Swiss  officer 
from  the  Orisons  fell  dangerously  ill  of  the  fever  at  San 
Fiorenzo,  and  having  requested  to  be  removed  to  fort  Vi- 
vario, the  garrison  of  which  belonged  to  his  own  regiment, 
he  was  restored  to  life  and  health  in  less  than  a  fortnight. 
The  physician  having  repeated  the  experiment  on  some 
French  soldiers  in  the  hospital,  it  succeeded  so  well,  that  it 
has  become  the  established  practice,  to  send  thither  all  the 
desperate  cases  of  fever,  which  appear  to  be  past  the  power 
of  medicine;  and  if  is  observed,  that  the  fever  has  never  held 
out  there  beyond  the  eleventh  day."— Fo/net/  on  the  Climate 
and  Soil  of  the  U.  States,  p.  289. 

In  addition  to  the  above  fact,  1  can  state  from  my  own 
knowledge,  two  circumstances  no  less  illustrative  of  the  po- 
sition advanced  by  Dr.  Gregory  in  the  text.  They  occurred 
on  board  of  the  late  United  States  Frigate  Essex,  while  I 
was  surgeon  of  that  vessel.  We  were  anchored  in  Plymouth 


44 

any  medicines  whatever;  for  the  powers  of  nature  are 
alone  sufficient  to  cure  diseases,  when  every  obstacle 

sound  (England)  from  the  11th  of  January,  1811,  till  the 
14th  of  February  following,  and  although  we  arrived  there 
after  a  cold  and  stormy  passage  of  fourteen  days  from  Port 
Louis  roads,  in  France,  we  had  but  fourteen  cases  on  the 
sick  list.*  Plymouth  sound  is  exposed  to  the  piercing  cold 
and  moist  winds  from  the  British  channel,  as  well  as  the 
frigid  blasts  from  the  bleak  shores  of  Cornwall  and  Devon- 
shire; the  number  of  sick  of  consequence  soon  increased, 
and  in  fact  in  a  few  days  the  sick  list,  which  was  daily  aug- 
mented, was  crowded  with  many  cases  of  pleurisy,  violent 
inflammatory  catarrhs,  and  numbers  of  bad  colds,  all  of 
which  I  found  it  difficult  to  subdue.  On  the  fifteenth  of  Feb- 
ruary, the  ship  was  got  under  weigh  and  moored  in  Barn- 
pool,  immediately  under  the  elevated  shores  of  Mount  Edg- 
cumbe,  which  effectually  sheltered  the  decks  from  the  chan- 
nel winds,  while  the  neighbouring  mountains  on  the  other 
side,  screened  them  from  the  penetrating  shore-blasts.  A 
day  or  two  after  this,  all  the  patients  began  to  mend,  and  in 
a  few  more  they  were  quite  recovered.  The  other  fact  is  not 
less  interesting,  and  is  as  follows:  We  arrived  in  Cowes 
Roads,  Isle  of  Wight,  on  the  12th  of  April,  181 1,  from  Cher- 


*  Four  of  this  number  were  consumptive  patients  received  from  a  French 
hospital,  of  whose  cases  I  shall  afterwards  have  occasion  to  say  something, 
two  of  Catarrh,  one  of  Scrophula,  one  of  Hydrops  Articuli,  two  of  Syphilis^ 
three  of  Chronick  Rheumatism,  and  one  of  Contusion. 


45 


to  the  recovery  of  the  patient  is  taken  away.  Some- 
times however,  the  injury  which  the  system. has  rc- 

bourg,  in  France,  having  only  anchored  after  our  passage 
from  that  place  one  night  at  St.  Helens.  At  this  time  we  had 
but  eleven  on  the  sick  list,  although  a  day  or  two  after  I 
learned  that  the  British  fleet  at  Spithead,  no  great  distance 
from  us,  had  been  visited  by  an  epidemick  catarrh,  or  in- 
fluenza, which  was  rapidly  extending  itself.*  The  air  was 


*  The  following  was  the  state  of  the  sick  list  after  the  day  of  oiu- arrival  at 

Cowesj: — 

On  the  13th  of  April  there  were  sick, 

14 

14th,  also. 

- 

14 

15th, 

- 

IS 

16th, 

- 

14 

17th, 

- 

14 

18th,       - 

- 

16 

19th, 

- 

15 

20th,       - 

- 

13 

21st, 

IS 

22d, 

. 

13 

23d, 

. 

14 

24th,       -          -        - 

- 

14 

26th, 

. 

10 

27th,       - 

. 

9 

28th, 

. 

9 

29th,       -         -  _      - 

- 

10 

SOth, 

- 

10 

1st  of  May, 

- 

11 

2d,  3d,  4th,  5th,  &  6th, 

same, 

11 

7th, 

- 

70 

8tli,       - 

. 

78 

9th,  some  chronick  cases  dis- 

charged,       [- 

- 

Vo 

10th,    .... 

. 

.77 

nth. 

. 

99— sailed  fromCowes  Roads. 

46 

ceived  from  these  causes  is  so  extensive,  that  even 
m  the  event  of  the  patient  being  removed  beyond 

moist,  cold  and  hazy,  and  the  wind  very  variable.  In  a  few 
days  this  influenza  appeared  on  board  of  the  Essex,  and  the 
sick  list  increased  till  the  eleventh  of  May  when  it  was  at  its 
maximum,  there  being  on  it  99  cases  of  violent  inflamma- 
tory catarrh.  This  complaint  had  been  daily  extending  itself 
throughout  the  ship,  and  had  we  not  left  that  anchorage  I 
have  no  doubt  but  that  in  a  few  days,  every  creature  on 
board  would  have  been  afl*ected  with  it.  On  the  eleventh 
however  we  sailed  from  Cowes  and  anchored  in  the  afternoon 
of  that  day  in  Yarmouth  roads,  Isle  of  Wight.  I  found  all 
the  patients  better  on  the  next  morning,  and  discharged 
forty-four.  We  left  Yarmouth  that  morning,  aiTd  saited  out  of 
the  English  Channel  at  mid-day  on  the  thirteenth.  From  this 
time  the  list  rapidly  decreased,  so  that  on  the  seventeenth 
following  there  were  but  fourteen  sick.  I  must  not  omit  to 
mention  that  the  same  plan  of  treatment  was  pursued 
throughout,  so  that  the  change  of  place,  assisted  perhaps 
by  the  motion  of  the  vessel,  and  the  sea-sickness,  effected  the 


12th  of  May,  44  discharged,  55 — Yarmouth  Roads. 

13th,  6  more  discharged,  49  remaining. 

14th,  7  discharged,  42  remaining, 

15th,  3  discharged,  39  remaining. 

16th,  6  discharged,  33  remaining. 

17th,  19  discharged,  and     14  remaining. 

The  sick  Hst  remained  pretty  nearly  in  this  state,  and  on  the  first  of  June 
there  remained  on  it  hut  twelve,  and  most  of  those  were  chronick  cases,  and 
contusions  from  accidents. 


47 

the  sphere  of  their  influence,  it  requires  the  judicious 
use  of  proper  medicines  for  a  long  course  of  time, 
before  the  constitution  can  be  restored  to  its  former 
healthiness.  Yet  even  in  these  instances,  the  same 
caution  is  necessary  to  be  observed  in  the  curative 
intention,  namely,  the  removal  of  the  remote  causes; 
for  the  cure  of  no  disease  can  ever  be  reasonably 
expected,  while  its  causes  continue  to  operate — since 
they  daily  renew  and  augment  the  mischief  they  first 
produced. 

Lastly,  there  are  remedies  which  are  nearly  allied 
in  their  action  upon  the  system,  to  the  effects  of  a 
warm  climate.  For  instance:  the  warm  bath,  mild  di- 
aphoretics, especially  diluents,  warmer  and  more 
abundant  clothing  than  common,  particularly  flannel 
jackets  worn  next  to  the  skin,  frictions,  frequent  and 
moderate  exercise — all  excite  perspiration,  and  pro- 
mote an  equable  circulation  of  the  fluids.  Remedies 
of  this  kind,  as  well  as  moderate  heat,  such  as  pre- 
vails in  this  island  during  the  summer  season,  are  of 
great  use  in  various  disorders.  And  since  a  moderately 
warm  climate  is  observed  to  produce  similar  effects, 
is  it  not  very  reasonable  to  advise  a  journey  into  coun- 
tries enjoying  such  a  climate?  Thus  thtn  from  ana- 


48 

logy  of  the  effects  produced  by  the  remedies  we  have 
mentioned,  it  may  easily  be  inferred,  that  a  change 
of  climate  promises,  in  many  disorders,  great  advan- 
tages. 

Finally,  from  attentive  consideration  of  those  cir- 
cumstances which  have  an  injurious  effect  upon  any 
particular  disorder,  we  may  plainly  deduce  the  infer- 
ence: that  a  change  of  climate  will  prove  a  useful  re- 
medy. For  example:  cold  air  inspired  into  the  lungs 
excites  coughing  by  producing  an  oppression  of  the 
chest;  now  this  very  agent  increases  the  disease.  Gouty 
persons  also  suffer  not  a  little  inconvenience  from  the 
same  cause  (to  wit,  cold  air.)  Yet  persons  so  affected 
have  it  not  in  their  power  to  avoid  such  an  inconve- 
nience without  going  abroad  into  other  countries, 
since  their  continuance  in  this  island  subjects  them 
to  perpetual  exposure  to  its  noxious  atmosphere.  Ex- 
perience proves  therefore,  that  in  these  and  similar 
cases  there  is  something  in  our  climate  prejudicial  to 
the  sick,  and  though  it  may  not  absolutely  be  the 
cause  of  the  malady,  yet  we  may  reasonably  con- 
clude that  a  change  of  air  would  be  of  advantage: 
since  great  inconvenience  and  hazard,  scarcely  evita- 
ble  in  any  other  manner,  will  be  easily  warded  off. 


49 

For  these  reasons  particularly,  if  I  am  not  mista- 
ken, a  change  of  air  by  means  of  a  journey  into  coun- 
tries that  have  the  advantage  of  a  moderately  warm, 
dry,  mild,  and  uniform  climate,  will  be  of  infinite 
service  in  m^ny  diseases  incidental  to  this  island.  It 
must  be  observed  however,  that  whatever  benefit  the 
sick  derive  from  such  a  journey,  must  not  be  at- 
tributed altogether  to  a  change  of  air  and  climate, 
since  they  receive  at  the  same  time  the  advantage  of 
gentle  and  long  continued  exercise,  which  itself  acts 
as  a  remedy  scarcely  less  efficacious,  in  many  com- 
plaints at  least,  than  a  change  of  sun.  When  the  situ- 
ation of  our  patients  is  such  as  to  require  a  milder 
climate,  they  are  often  obliged  to  perform  a  long 
journey  of  many  weeks;  and  all  physicians  know  that 
such  journies  produce  powerful  and  often  salutary 
effects  on  the  human  system.  In  a  dissertation  on  the 
effects  of  a  change  of  climate,  the  virtues  of  exer- 
cise are  not  indeed  particularly  to  come  under  con- 
sideration; yet  I  do  not  think  it  foreign  to  the  pur- 
pose to  say  a  few  words  on  this  subject.  In  fact  it 
cannot  be  deemed  irrelevant  to  our  reasoning;  for 
the  effect  of  exercise  should  always  be  taken  into 
consideration  when  we  recommend  a  change  of  cli- 
mate. The  effects  of  both  indeed  are  synchronous, 

G 


50 

and  they  produce  nearly  the  same  consequences,  at 
least  in  the  generality  of  cases,  on  the  constitution. 
Besides,  both  reason  and  experience  satisfactorily 
prove,  that  moderate  and  continual  exercise,  such  as 
arises  from  a  long  journeys—promotes  perspiration 
and  a  determination  of  the  fluids  to  the  surface;  and 
there  is  no  doubt  but  that  many  sick  persons  derive 
great  relief  from  the  effect  of  this  exercise  alone. 
Further  than  this,  I  am  much  mistaken  if  the  cures 
of  many  diseases  which  are  commonly  imputed  to 
a  change  of  air,^  are  not  to  be  attributed  to  the  in- 
fluence of  this  exercise. 

»  The  common  practice  in  this  and  other  countries  of  ad- 
vising valetudinarians  to  repair  to  vs^atering  places  for  the 
benefit  of  the  chalybeate  waters,  is  proved  by  experience  to 
be  a  judicious  one.  Yet  so  great  is  the  advantage  frequently 
resulting  from  these  visits,  that  it  would  be  unreasonable  to 
impute  it  solely  to  the  effect  of  drinking  the  waters.  To  the 
journey  itself  undoubtedly,  and  the  exercise  and  change  of 
scene  and  air  resulting  from  it,  as  well  as  to  the  invigorat- 
ing influence  of  pleasant  company  and  the  hilarity  derived 
from  new  and  sometimes  facetious  companions,  is  to  be  re- 
ferred, all  the  good  effects  of  these  trials.  Dr.  Rush  remarks 
in  his  essay  on  pulmonary  consumption,  that  "  the  sulphu- 
rous and  saline  air  of  Libya  between  Mount  Vesuvius,  and 
ihe  Mediterranean  Sea,  and  the  effluvia  of  the  pine  forests 


51 

When  it  is  judged  expedient  to  make  trial  of  a 
change  of  cHmate  with  a  view  to  its  effects  as  a  reme- 
dy, a  question  arises  whether  the  patient  should  travel 
by  sea  or  by  land?  It  clearly  appears  from  the  observa- 
tions of  many  physicians  of  ancient  times  as  well  as  of 
modern  days,  that  a  voyage  alone,  avails  in  no  incon- 
siderable degree,  in  many  complaints.  The  celebrat- 
ed Gilchrist  published  a  beautiful  dissertation  a  few 
years  since,  on  the  medical  use  of  sea  voyages,  in 
which  he  plainly  proves  the  remediate  effects  of  sail- 
ing, and  indeed  it  appears  from  his  work,  that  in 
many  diseases  it  acts  as  a  most  efficacious  remedy. 
He  relates  the  histories  of  many  invalids  who  evident- 
ly were  snatched  from  the  very  jaws  of  the  grave,  as 
it  were,  by  the  salutary  operation  of  this  remedy. 
Many  things  which  occur  during  a  voyage  combine 
without  doubt,  in  producing  such  an  effect;  and  I  am 

of  Libya,  were  supposed  in  ancient  times  to  be  powerful 
remedies  in  consumptive  complaints;  but  it  is  probable 
the  exercise  used  in  travelling  to  those  countries,  contribu- 
ted chiefly  to  the  cures  which  were  ascribed  to  foreign  mat- 
ters acting  upon  the  lungs." — Medical  Inquiries,  Vol.  II. 
Page  145. 


52 

not  disposed  to  denys  that  the  moisture  and  equal 
temperature  of  sea  air,  the  saline  vapours,  and  other 

9  The  temperature  of  sea-air  is  unquestionably  more  uni- 
form, and  warmer  than  the  atmosphere  of  land.  It  has 
also  been  proved  to  be  purer.  Dr.  Ingenhousz  in  a  short 
voyage,  instituted  a  series  of  experiments  with  a  view  to 
ascertain  this  fact.  These  are  related  in  the  70th  vol.  of  the 
Philosophical  Transactions.  He  is  of  opinion,  that  the  air 
of  the  sea,  is,  caeteris  paribus,  purer  than  that  of  land.  His 
observations  however  were  not  made  in  different  latitudes. 
In  an  ingenious  paper  by  Dr.  Adam  Seybert  containing  ob- 
servations on  land  and  sea  air,  published  in  the  Transactions 
of  the  American  Philosophical  Society  (Vol.  4.  p.  262,  No. 
32)  we  have  the  results  of  some  experiments  performed  by 
the  doctor  in  different  latitudes,  and  during  different  hours 
of  the  day.  I  will  give  these  results  in  the  words  of  the  au- 
thor: 

"  My  experiments  at  sea  sufficiently  prove  that  the  at- 
mosphere is  considerably  purer  there  than  it  is  on  land. 
Though  there  are  some  trifling  differences  in  the  results  of 
sevei'al  experiments,  I  have  no  reason  to  believe  that  they 
were  owing  to  the  different  situation  in  point  of  latitude  or 
longitude  in  which  they  were  performed.  I  can  form  no  sys- 
tem respecting  such  variations.  Winds,  temperature,  rain^ 
&;c.  do  not  seem  to  have  produced  them.  As  they  did  not  ob- 
serve any  regularity  in  their  occurrence,  they  may  perhaps 


53 

advantages,  may  have  a  good  effect.  But  it  is  my  opi- 
nion that  whatever  benefit  is  derived  from  sailing  is 
to  be  imputed  especially  to  exercise  itself.  Gilchrist 
has  happily  shown  that  sailing  produces  a  sufficient 
degree  of  exercise  for  health,  especially  if  the  vessel 
be  small  and  the  sea  rough.  He  shows  also  that  this 

be  attributed  to  certain  unperceived  errors  which  are  una- 
voidably attendant  on  such  trials. 

"  That  the  air  at  sea  should  appear  nearly  of  the  same  pu- 
rity in  different  latitudes  does  by  no  means  astonish  me;  for 
if  land  air  has  certain  matters  mixed  with  it  they  are  fierhafis 
absorbed;  and  if  my  supposition  be  true,  that  the  influence 
of  the  sun's  rays  on  the  water  tends  to  increase  its  purity, 
the  opinion  I  entertain  is  not  surprising.  For  when  once 
purified,  there  are  perhaps  none,  or  few  causes  to  render  the 
air  noxious  aftdr  it  is  wafted  from  our  towns  and  cities  over 
a  large  body  of  water. 

"  It  occurred  to  me  that  probably  the  purity  of  the  air  at 
sea  varied  at  different  periods  of  the  day;  to  satisfy  myself 
on  this  point  I  made  several  trials  on  the  10th  and  17th  of 
June  last.  On  the  10th  I  performed  them  at  9  o.clock  A.  M. 
at  12,  and  at  6  o'clock  P.  M.  On  the  17th  at  9  A.  M.  and  at 
12  o'clock.  The  result  of  all  the  experiments  of  the  same 
day  was  exactly  similar,  at  least  not  perceptibly  different." 


54 

exercise  possesses  certain  advantages  peci\liar  to  it- 
self, and  in  particular  cases,  far  excels  all  other  kinds. ^'^ 

w  I  am  sure  it  will  not  be  uninteresting  to  give  at  length, 
the  observations  of  Dr.  Gilchrist  on  the  peculiar  kind  of  ex- 
ercise produced  by  sailing.  They  are  so  pertinent  and  true, 
that  I  need  offer  no  apology  for  the  quotation. 

"  Sailing  seems  to  correspond  with  most  other  exercises 
in  their  manner  of  acting,  or  their  effects,  and  indeed  to 
.comprehend  them  all.  When  it  is  not  vehement  it  resembles 
walking,  in  the  gentle  continued  action  of  the  muscles  with 
which  that  exercise  is  accompanied,  when  used  in  a  mode- 
rate degree.  The  benefit  derived  from  riding  depends  upon 
the  continued  succussion  which  the  body  suffers,  and  on  be- 
ing carried  with  considerable  quickness  through  the  air. 
Now,  in  sailing,  there  is  a  greater  succussion  from  the  vo- 
miting; and  in  a  ship  driven  by  winds,  a  person  is  carried 
through  the  air  with  greater  quickness  tham  in  any  other 
ordinary  exercise.  Again,  at  sea  a  various  action  of  tiie  mus- 
cles is  produced  by  the  motion  of  the  ship,  and  the  constant 
efforts  that  must  be  used  to  prevent  falling;  by  which  the 
body  is  put  into  all  that  variety  of  constrained,  ever-chang'- 
ing  attitudes  observed  in  bowling,  skating,  rowing,  and  the 
like  exercises,  and  in  common  labour.  Exercise  in  a  swing, 
or  a  coach,  which  sometimes  causes  vomiting,  comes  nearest 
to  sailing,  as  does  likewise  our  first  exercise,  the  cradle. 

"  Sailing 


55 

Another  remedy  indeed  besides  exercise  is  obtained 
by  sailing,  namely,  that  denominated  sea- sickness", 

"  Sailing  then  is  an  exeixise  compounded  of  gestation,  and 
that  of  a  particular  kind;  a  preternatural  spasmodic  motion 
in  vomiting;  and  a  singular  action  of  the  air:  nor  can  any- 
other  exercise  lay  claim  to  so  many  and  such  peculiar  ad- 
vantages. 

«  It  is  constant:  for  as  the  ship  is  in  perpetual  motion,  day 
and  night,  sleeping  and  waking,  one  or  other  of  these  causes 
always  takes  place,  contrary  to  all  other  exercises,  in  which 
the  sick  are  usually  employed  but  a  short  while  together, 
and  the  intervals  between  the  times  of  exercise  are  long. 

«  Though  sailing,  considered  in  all  its  complex  circum- 
stances, and  powerful  effects,  is  reckoned  among  the  highest 
exercises,  so  as  in  some  to  cause  great  perturbation,  it  is 
really,  after  being  a  little  used  to  it,  the  most  gentle,  and 
excites  no  irregular  motion,  or  undue  impetus  of  the  fluids, 
with  subsequent  waste  of  them.  Therefore  it  is  not  attended 
with  lassitude,  or  lowness  of  spirits,  with  hurry  and  confu- 
sion, as  other  exercises  often  are.  A  man  may  sit  or  stand, 
walk,  lean,  or  lie,  as  he  likes  best,  and  so  relieve  his  body 
by  a  frequent  change  of  posture,  and  prevent  weariness. 
Other  exercises  of  efficacy  cannot  be  undertaken  by  those 

[For  Note  11,  see  next  Page,] 


56 

which  frequently  excites  nausea  and  vomiting.  This 
produces  powerful,  and  in  some  diseases  most  benc- 

\ 
who  are  weak  and  wasted,  under  fever  and  inflammation,  or 
in  a  colliquative  state,  and  many  other  such  cases;  and  lower 
exercises  are  insufficient  for  any  great  purpose  of  cure.  But 
sailing  is  of  mighty  energy,  yet  safe;  and,  excepting  the  sea- 
sickness at  first,  is  easily  sustained.  Scarce  any  circumstance 
of  a  disease  in  which  it  is  proper,  can  forbid  its  use,  while 
the  frame  of  the  body  or  mind  is  not  too  much  broken,  nor 
any  part  corrupted:  nay,  even  in  this  last  case  it  is  often 
highly  proper. 

"  To  all  these,  as  farther  advantages,  we  may  add,  that  at 
sea,  you  constantly  breathe  a  peculiarly  salutary  air;  and 
that  the  action  of  the  air  is  greater,  and  increased  by  your 
being  often  carried  through  it  with  uncommon  velocity. 
There  is  likewise  a  greater  action  of  the  muscles,  of  all 
the  muscles  of  the  body,  of  muscles  not  exercised  in  any 
other  ordinary  exercise,  or  not  exercised  in  the  same  man- 
ner, nor  so  forcibly,  nor  with  such  effects  and  continu- 
ance. Nor  is  there  occasion,  in  undertaking  a  voyage,  for  so 
many  precautions  as  are  necessary  to  be  observed  in  other 
exercises."— -Gi/cAns?  on  the  Use  of  Sea  Voyages  in  Medi- 
cine^ p.  17. 

1*  The  prominent  features  of  the  nausea  maritima  are 
Striking  and  deserving  of  much  consideration.  When  a  per- 


57 

ficial  effects.  It  was  known  a  long  time  ago  to  physir 
cians,  that  nausea  and  vomiting  were  eminently  us^- 

son  goes  to  sea  for  the  first  time,  he  is  commonly  affected 
immediately  upon  his  coming  into  blue  water,  as  sailors  term 
it,  with  slight  giddiness  of  the  head  and  a  sense  of  tightness 
across  the  forehead;  considerable  and  distressing  nausea;  a 
sense  of  motion  in  the  stomach,  and  soon  after  violent, 
copious  and  convulsive  vomiting.  These  effects  generally 
continue  for  a  few  days,  during  which  time  they  are  most 
aggravated  by  an  upright  position  of  the  body  below  decks, 
and  less  severe  while  inhaling  the  free  air  on  deck,  and 
in  an  horizontal  position  of  the  body  when  below.  The  nau- 
sea is  always  painfully  increased  by  the  odour  of  cooked 
meats,  and  especially  by  the  disagreeable  and  peculiar  smell 
of  the  bilge  water  pumped  up  at  a  regular  hour,  every  evening. 
The  odour  from  this  putrid  water  is  so  nauseous  and  subtle, 
that  it  insinuates  itself  into  all  parts  of  the  vessel,  and  while 
its  power  on  the  surrounding  air  is  at  its  height  it  equally 
affects  with  disagreeable  feelings,  the  veteran  seaman  and 
the  tyro  in  sailing,  producing  on  the  latter  however,  infalli- 
bly, the  most  violent  and  convulsive  puking.  The  motion  of 
a  vessel  through  the  water  is  vehement,  rapid,  sometimes 
irregular,  and  in  turbulent  weather  much  interrupted  by 
sudden  lurches.  That  a  violent  commotion  is  communicated 
to  the  system  by  these  combined  motions,  must  seem  evident 
to  every  one,  but  the  peculiar  effects  and  operation  of  it  upon 
the  mind  ajid  body  of  the  person  who  may  be  the  subject  of 

H 


58 

ful  in  exciting  perspiration,  and  in  promoting  and 
restoring  the  due  circulation  of  the  fluids  to  the  ex- 
it, can  only  be  thoroughly  known  by  those  who  have  expe- 
rienced it  in  their  own  persons.  It  must  seem  clear  however, 
to  every  reflecting  mind,  that  as  this  motion  of  the  vessel  is 
constant,  though  in  a  greater  or  less  degree,  a  person  at 
sea  must  be  sensible  of  some  permanent  effect  on  the 
system,  liable  to  augmentation  and  diminution  in  propor- 
tion as  the  weather  is  calm  or  turbulent.  This  accordingly 
is  the  case,  and  there  are  few  persons  who  are  not  affected 
by  costiveness,  not  only  immediately  after  going  to  sea,  but 
in  some  degree  subject  to  it  all  the  time  they  continue  there. 
This  effect  I  believe  to  be  in  no  way  dependant  on,  or  in  con- 
sequence of  the  peculiar  aliment  that  is  generally  eaten  at 
sea,  but  owing  solely  to  the  continual  impulse  communicated 
to  the  stomach  and  intestines  by  the  rolling,  tossing  about  and 
pitching  of  the  vessel.  I  infer  this  from  the  fact  that  this  cos- 
tiveness exists  in  a  greater  degree,  in  persons  sailing  in  small 
vessels,  of  which  the  motion  is  short,  quick,  and  pitching, 
than  in  larger  vessels,  as  in  frigates,  where  it  is  long  and  less 
often  repeated  in  a  given  time  Now  though  the  more  vio- 
lent affection  of  the  stomach  for  the  most  part  goes  off  after 
four  or  five  days,  or  at  farthest  in  a  week  or  ten  days,  there 
is  nevertheless  a  certain  kind  of  affection  of  that  organ,  and 
which  indeed  is  in  a  degree  communicated  to  the  system 
generally,  that  comes  on  during  every  heavy  blow:  namely  a 
sensation  when  the  ship  lurches  or  pitches  forwards  as  if  one 


59 

ternal  parts.  They  act  powerfully  also  in  promoting 
expectoration,  when  the  lungs  are  oppressed  with 

was  falling,  and  upon  the  rising  of  the  vessel  upon  the  waves 
again,  as  if  one  was  raised  with  it.  This  sensation,  which  is 
felt  in  the  greatest  degree  when  there  is  a  cross  or  head 
sea,  or  when  the  ship,  going  before  the  wind,  lurches  from 
side  to  side,  communicates  to  the  abdominal  muscles  a  con- 
vulsive and  sudden  action,  so  that  the  whole  contents  of  the 
abdomen  are  compressed  and  expanded  alternately  with  the 
rising  and  falling  of  the  ship.  This  compression  consequently 
operates  on  the  diaphragm,  forcing  that  muscle  upwards  in 
the  same  violent  and  convulsive  manner,  so  that  the  visdera 
of  the  thorax  are  also  sensibly  compressed  and  expanded 
with  the  lurching  and  righting  of  the  vessel.  These  ef- 
fects as  I  have  before  remarked  are  produced  with  every 
new  turbulence  of  the  sea,  and  as  they  are  totally  indepen- 
dent of  the  nausea  and  sickness  before  mentioned,  may  be 
considered  as  the  more  permanent  effects  of  sailing.  One 
other  effect  of  the  vessel's  motion,  is  the  constant  and  novel 
action  of  the  muscles  of  the  body,  principally  those  of  the 
lower  extremities,  to  preserve  an  equipoise  and  to  prevent 
falling.  The  centre  of  gravity  constantly  altering  as  res- 
pects locality,  a  continual  and  corresponding  action  of  the 
muscles  to  preserve  an  equilibrium,  is  of  course  necessary; 
and  this  continual  action  of  the  muscles,  novel,  sudden  and 
cnergetick,  is  the  most  permanent  of  the  effects  of  sail-* 
ing.  It  is  the  exercise  arising  from  this  action  of  the  mus- 


phlegm*  A  vomiting  of  this  kind  however  cannot  be 
long  employed  unless  produced  by  sailing;  in  this 

cles,  that  brings  such  invigoration  to  the  debilitated  patient; 
fifid  this  action  never  ceases  to  be  necessary  during  the 
slightest  motion  of  the  sea,  except  in  a  horizontal  position  of 
the  body,  and  even  then,  in  blowing  weather  one  is  frequently 
awakened  from  sleep  by  an  involuntary  exertion  to  avoid 
being  thrown  from  the  berth.  I  have  uniformly  observed  that 
those  persons  who  were  slightly  affected,  or  affected  not  at 
all,  with  vomiting,  or  nausea,  suffered  excessively  from  an 
affection  of  the  mind  and  frequently  from  acute  pain  in  the 
head,  which  was  always  considerably  aggravated  by  the  vio- 
lent pitching  of  the  ship*  Such  are  the  effects  of  sailing  upon 
the  system  as  I  have  observed  them,  both  in  small  vessels 
as  packets,  sloops  of  war,  and  in  larger  ones  as  frigates.  I 
have  never  witnessed  but  three  very  distressing  cases  of 
sea-sickness,  one  a  landman  on  board  of  the  frigate  United- 
States,  in  whom  great  emaciation,  loss  of  appetite,  and  a  ha- 
bitual convulsive  retching:  which  continued  after  the  ship 
came  to  anchor:  and  the  other  two,  which  were  on  board  of 
the  Essex,  are  particularly  mentioned  in  my  "  Treatise  on 
Marine  Hospitals,  &c."  p.  153. 

The  exercise  of  sailing  is  not  only  performed  in  a  fine 
healthy  and  pure  air,  but  it  is  constant  in  itself.  The  veteran 
seaman  has  the  same  continual  action  of  nearly  all  the  mus- 
cles of  the  body,  perpetually  exerting  its  salutary  effects  on 
the  system,  as  the  young  sailor  is  subject  to.  But  the  mind 


manner  it  is  not  uncommonly  excited  for  many  days 
in  succession,  or  during  entire  weeks;  and  experience 

loses  in  the  first  instance,  by  the  influence  of  habit,  its  con- 
sciousness of  this  continued  exertion  of  the  muscles.  In  the 
latter  case  the  exercise  and  consequences  of  sailing,  are  so 
novel  and  positive,  that  the  mind  dwells  on  them  with  more 
attention,  until  time  and  habit  produce  also  on  the  new  sailor, 
the  same  unconsciousness  of  the  perpetual  exertions  of  the 
body  to  preserve  its  proper  position  and  to  prevent  falling 
prostrate  with  every  pitch  of  the  vessel.  The  same  uncon- 
sciousness of  the  operations  of  the  mind  and  the  synchronous 
action  of  the  muscles  of  the  body,  takes  place  in  many  of 
our  common  actions,  which  from  long  practice  are  so  adroitly 
performed  that  we  frequently  are  inclined  to  believe  them, 
and  they  ordinarily  appear  to  others  to  be  involuntary; 
Thus  for  example  the  successive  rapid  and  almost  imper- 
ceptible movements  of  the  fingers,  and  the  synchronous 
actions  of  the  muscles  of  the  tongue,  mouth  and  lips,  in 
playing  on  the  German  flute,  seem  after  long  practice, 
to  be  independent  of  any  act  of  the  mind,  since  we  are 
inclined  to  think  it  cannot  produce  such  vehement  and 
rapid  operations.  Yet  here,  each  movement  of  the  fingers 
and  every  action  of  the  muscles  before  mentioned,  are  the 
effect  of  a  distinct  and  vivid  act  of  volition. 

This  continual  exercise  of  the  muscles  then  when  a  ship 
is  under  sail,  and  which  I  have,  before  remarked  is  in  some 


62 

proves  that  no  danger  or  injury  arises  from  it.  Yet 
can  I  hardly  believe,  that  a  similar  sickness  produced 
by  the  operation  of  artificial  emcticks,  could  be  ex- 
cited for  any  time,  without  danger.  At  least  few  phy- 
sicians woiild  recommend  the  experiment,  nor  would 
any  patients  follow  such  advice,  but  on  the  contrary 
would  shrink  with  fear  from  so  disagreeable  a  reme- 
dy. After  the  sickness  has  gone  off,  persons  at  sea 
enjoy  excellent  health,  and  have  a  keen  appetite,  not- 
withstanding they  are  almost  without  any  other  ex- 
ercise than  what  is  derived  from  the  motion  of  the 
ship  itself.  This  motion  as  Gilchrist  has  properly  re- 
marked, although  a  kind  of  gestation,  performs  the 

measure  performed  even  during  sleep,  is  one  of  the  most 
salutary  effects  of  sailing.  By  means  then  of  this  gentle  and 
regular  exercise,  the  circulation  of  the  blood  is  vigorously 
promoted  through  every  part  of  the  body,  producing  so 
healthy  an  action  in  the  minute  vessels  of  the  surface,  that  a 
uniform  and  copious  perspiration  is  effected.  This  is  carried 
off  as  fast  as  it  is  exhaled  from  the  surface  of  the  body,  by 
the  change  of  atmosphere  and  the  perpetual  succession  of 
its  stimulating  effects  on  the  skin.  Hence  it  is  that  ther.e  is 
always  so  intense  and  impatient  an  appetite  felt  at  sea;  for 
the  food  taken  into  the  system  after  undergoing  the  cus- 
tomary alterations,  speedily  passes  off,  that  is,  the  liquid 
portion  of  it,  by  perspiration. 


63 

office  of  exercise,  and  promotes  the  healthy  circula- 
tion of  the  fluids.  Besides  this,  another  and  natural 
exercise  is  accomplished  by  sailing.  For  according 
as  the  ship  rises  on  the  waves  and  is  tossed  about,  a 
synchronous  motion  of  the  body  is  required,  so  that 
its  position  and  equipoise  may  be  subservient  to  the 
vascillation  of  the  vessel;  otherwise  no  person  would 
be  able  to  move,  or  scarcely  to- stand  or  sit.  In  order 
to  perform  this  motion,  a  moderate,  frequent,  and 
scarcely  sensible  exercise  of  almost  all  the  muscles 
of  the  body  is  required;  and  this  exercise  is  perform- 
ed  without  any  intermission;  so  that,  whenever  any 
one  takes  a  voyage  he  has  the  benefit  of  exercise,  or 
at  least  of  gestation,  all  the  time  he  lies  down  in  bed, 
or  sleeps.  Whatever  good  therefore  is  derived  from 
regular  moderate  and  continual  exercise,  in  any  dis- 
ease, is  reasonably  to  be  expected  from  sailing  in 
preference  to  all  other  exercises.  I  am  by  no  means 
ignorant  that  this  remedy  has  been  ineffectually  tried 
in  many  cases;  but  I  know  that  the  most  advantage- 
ous effects  have  been  reaped  from  it,  in  others.  And 
if  any  one  will  reflect  upon  the  nature  of  those  cases 
in  which  it  has  generally  been  employed,  he  will  not 
be  at  all  surprised  that  it  has  not  always  succeeded 
as  might  have  been  wished.    For  a  trial  of  it  is 


64 

rarely  ever  resorted  to  except  in  very  dangerous,  and 
not  uncommonly  altogether  incurable  diseases,  as 
pulmonary  consumption  for  example:  indeed  it  often 
happens  that  the  patients  do  not  undertake  the  voy- 
age, until  they  are  in  the  last  stage  of  the  disease, 
and  all  medical  men  know  that  when  this  complaint 
has  continued  for  any  length  of  time,  the  lungs  arc 
so  affected  as  to  be  almost  incurable.  ^^ 

"  It  appears  that  Dr.  Gregory  attributes  to  the  effects  of 
exercise  alone,  all  the  good  derived  from  sea-voyages,  while 
Dr.  Thomas  Reid  on  the  contrary  attributes  their  beneficial 
effects  in  pulmonary  consumption,  solely  to  the  action  cre- 
ated in  the  stomach,  by  the  rolling  and  tossing  of  the  vessel. 
Indeed  ih  this  opinion  he  is  confirmed  by  the  histories 
related  by  Gilchrist,  who  has  proved  that  many  persons  la- 
bouring under  a  pulmonary  affection  were  cured  by  short 
voyages,  some  of  a  few  hours  only,  where  of  course  the  ex- 
ercise, however  advantageous  it  may  in  general  be,  was  not 
sufficiently  long  continued  to  have  had  any  share  in  these 
surprising  cures.  In  this  place  it  may  not  be  amiss  to  men- 
tion that  a  French  writer  speaking  of  the  effects  of  sea-voy- 
ages and  the  vomitings  they  produce,  in  pulmonary  con- 
sumption, advances  a  theory  relative  to  the  cause  of  these 
vomitings,  different  from  the  generally  received  opinion. 
His  words  are  as  follow:  "  Je  crois  que  le  mal  de  mer,  qui 
consist^e  dans  des  vomissemens  qui  se  continuent  pendant 


65 

We  all  know  that  other  kinds  of  exercise,  as  for 
instance,  riding  on  horse-back,  or  gestation  in  a  car- 
riage, upon  which  many  medical  writers,  and  parti- 
cularly Sydenham,  bestow  such  commendations,  al- 
though they  have  sometimes  been  very  successful, 
are,  nevertheless,  often  tried  in  vain.  Sailing  however 
possesses  a  great  advantage  over  all  other  exercises: 
that  is,  that  it  can  frequently  be  used  when  every 
other  kind  is  prohibited  on  account  of  the  debility 
of  the  patient.  For  this  is  so  gentle  and  mild,  that  for 
the  most  part  the  invalid  himself  is  scarcely  sensible 
of  it;  and  the  sick  can  bear  it  without  danger,  how- 
ever feeble  they  may  be.  Indeed  there  are  some  in- 
stances of  valetudinarians,  already  broken  down  by 
disease,  and  so  weak,  that  they  were  not  able  to 
move  themselves,  who,  after  being  carried  on  board 
ship,  and  having  performed  a  voyage,  have  recovered 

plusieurs  jours,  et  qui  meme,  chez  quelques  individus,  sc 
font  sentir  pendant  tout  le  trajet,  depend  autant  de  cette 
exaltation  des  forces  internes  qui  s'irritent  de  la  presence 
des  fluides  qui  devaient  appartenir  d  la  transpiration  cuta- 
nee,  que  de  la  march.e  vacillante  et  du  roulis  du  vaisseau.*' 
Traits  sur  la  Xature  et  le  Traitment  de  la  Phthisic  Piilmo- 
naire,  par  Julien  Bonnafox-Demalet^  M.  D.  p.  169. 


66 

both  their  health  and  strength."  In  those  cases  there- 
fore, where  the  patients  can  neither  bear  riding  on 
horseback  nor  gestation  in  a  carriage,  and  when  conse- 
quently they  are  incapable  of  performing  joiirnies  by 
land,  a  voyage  certainly  ought  to  be  tried.  But  when 
the  sick  are  able  to  travel  by  land  to  countries  suita- 
ble to  their  condition,  it  is  a  matter  of  doubt  whether 
a  voyage  should  be  preferred  for  this  purpose.  If  it 
should  be  long,  many  inconveniences  will  arise  from 
it,  particularly  on  account  of  the  food,  for  some  in- 
valids require  a  diet  consisting  of  milk"  and  fruit, 

13  For  a  history  of  many  interesting  cases  of  this  nature  I 
beg  leave  to  refer  the  reader  who  may  desire  further  infor- 
mation on  this  subject,  to  the  inestimable  work  of  Gilchrist. 

1*  With  regard  to  the  necessity  of  milk  as  an  essential 
constituent  of  the  diet  of  any  invalids  whom  it  may  be  deem- 
ed proper  to  send  to  sea  for  their  health,  it  may  not  be  amiss 
to  remark  that  as  this  article  was  chiefly  prescribed  in  pul- 
monary consumption  by  physicians  some  time  back,  and  as 
it  is  now  esteemed  rather  a  pernicious  than  an  useful  diet  in 
this  disease,  no  solid  objection  can  arise  from  the  want  of  it 
on  ship-board,  to  the  expediency  of  taking  a  voyage.  Whe- 
ther the  milk  of  the  ass  possesses  any  real  virtues  not  com- 
mon to  the  milk  of  the  cow  and  other  animals,  seems,  in  the 
opinion  of  physicians  of  this  day,  notwithstanding  the   ex- 


67 

which  can  scarcely  be  had  during  the  whole  of  a 
long  voyage;  besides  which  the  privations  arising 
from  it  affect  with  dread  and  disgust,  the  feelings  of 
men  accustomed  to  the  refinements  and  luxuries  of 
polished   life.**  I   would  hardly   venture   to   assert 

travagant  commendations  of  it  by  the  practitioners  who 
preceded  them  by  a  few  years,  to  be  very  problematical. 
But  it  appears  to  be  agreed  on  all  sides,  that  any  kind  of 
milk,  taken  by  a  consumptive  patient  in  sufficient  quantity 
to  produce  any  positive  effect,  will  for  the  most  part  do 
harm.  Professor  Barton  in  his  lectures  on  the  Practice  of 
Physick,  speaks  of  this  article  in  strong  terms  of  disappro- 
bation, so  far  as  regards  its  employment  as  a  diet  in  phthisis; 
and  says  he  has  known  many  instances  of  its  producing  a 
distressing  fulness  and  oppression  of  the  chest. 

"  I  confess  this  objection  to  sea  voyages  arising  from  the 
privations  that  must  be  endured,  strike  my  mind  with 
peculiar  force.  Objections  predicated  upon  such  grounds 
are  formidable  indeed.  No  human  being  can  be  susceptible 
of  stronger  emotions  of  disgust  and  wearisomeness  of  life, 
than  I  have  felt  at  sea,  from  the  necessity  of  encountering 
the  privations  of  retirement,  of  peace,  of  social  felicity,  for 
months  at  a  time  together.  Such  was  the  gloom  and  des- 
pondency with  which  I  was  constantly  affected  during  the 
prevalence  of  bad  weather,  that  I  was  always  firmly  con- 
vinced if  ever  I  should  have  fallen  ill  at  sea,  that  the  debili- 


68 

that  the  other  advantages  derived  from  sailing  can 
compensate  for  this  inconvenience;  nor  will  I  deny 

tating  effect  of  a  dejected  mind,  would  inevitably  have  pre- 
vented my  recovery.  Knowing  then  that  such  feelings  have 
existed  in  others,  and  having  experienced  them  in  myself, 
I  think  we  should  do  well  to  deliberate  seriously  and  long, 
on  the  temper  and  disposition  of  our  patients,  before  we 
venture  to  prescribe  a  sea  voyage  for  their  relief.  There 
are  unaccountable  repugnancies  to  the  turbulent  vexations 
of  a  sea  life,  as  well  as  lively  disgusts   at  the  inevitable 
want  of  cleanliness  that  depends  on  it,  which  many  men  feel 
acutely.  Would  it  not  be  a  precarious  practice  to  send  such 
to  sea?  And  if  the  stronger  sex  be  frequently  the  victims  of 
such  deep-rooted  and  unconquerablea  versions,  how  much 
more  frequently  must  we  not  expect  to  find  the  fragile  and 
delicate  female,  accustomed  in  her  indisposition  to  the  so- 
lacing comforts  derived   from  the   society  of  her  friends, 
perhaps  her  children:  as  well  as  to  the  kind  solicitude  of 
an  attentive  nurse — loathing  with  painful  disgust  the  very 
idea  of  existence,   while  the  distressing  sea-sickness  de- 
prives her  of  energy,  of  spirits,  and  of  the  attention  of 
her  attendants  whom  a  similar  sickness  perhaps  renders 
nearly  as  much  in  want  of  assistance  as  herself?  Nor  can 
I  subscribe  to  the  beneficial  eifect  attributed  by  some  to 
the  transitions  of  the  feelings  from  hope  to  fear  and  vice 
versa,  so  justly  said  to  be  common  at  sea.  Dr.  Gilchrist  in 
his  work  on  sea-voyages,  (p.  67.)  says, "  living  at  sea  must 


69 

that  a  journey  on  land,  performed  in  a  carriage, 
produces  highly  beneficial  effects,  resembling  those 

be  considered  as  having  a  mighty  influence  on  the  miQcl, 
which,  by  consent,  will  powerfully  affect  the  body.  In  sailing 
there  is  a  strange  mixture  of  passions;  and  these  are  some- 
times in  extremes.  Sea-faring  people  are  frequently  agita- 
ted between  hope  and  fear;  are  sometimes  merry,  sometimes 
sad;  exulting  with  joy  when  safe,  and  at  rest;  and  in  danger 
thrown  into  the  utmost  despair.  Such  variations  and  budden 
transitions  of  passions,  are  capable  of  removing  the  most  in- 
veterate diseases,  and  such  as  are  not  curable  by  any  other 
method.*'*  I  will  venture  to  assert  that  the  learned  author 
whom  I  have  just  quoted,  never  practised  mddicine  exten- 
sively on  ship-board  at  sea.  I  have  never  failed  to  observe 
the  prejudicial  nay,  I  may  say  in  some  instances,  the  fatal 
effects  on  my  patients  at  sea  of  the  violent  and  sudden  ebul- 
litions of  hope  succeeded  by  dejection  and  despair,  so  fre- 
quently produced  from  the  interest  almost  all  persons  take 
in  the  safety  and  comfort  of  the  ship  and  the  state  of  the 
weather.  I  have  known  a  paroxysm  of  an  intermittent  acce- 
lerated by  a  "  head-wind"  being  announced  to  the  unfortu- 
nate  subject  of  the  disease,  whose-hopes  of  happiness,  of 


*  Venim  gestatio  per  pelagus  vehementissiroa  est,  et  mutationes  plurimas, et 
maximas  facit  Nimirum  cum  anima  mLxtos  affectus  habeat,  ex  tristitia  et  spe, 
tiinore  et  j)ericuIo;  modo  gaudentibus  et  latis,  modo  in  agone  existentibus  na- 
vigantibus.  Omnia  hsec  composita  sufficientem  vim  habent  omaem  veterena 
xnorbum  exigei  di,  et  e  eorpore  exoludendi." — *Mtiu8  Medicin,  contract, 
tetrab.  prim.  serm.  3.  cap.  6. 


70 

too,  that  arise  from  sailing.  Those  therefore  who  are 
in  affluent  circumstances,  and  who  retain  strength 

health,  of  joy,  depended  on  the  speedy  arrival  of  the  vessel 
"  at  the  haven  v^here  she  would  be.**  Can  the  debilitating 
effect  of  depressing  emotions  be  less  active  at  sea  than  on 
land,  under  similar  circumstances?  Or  is  the  excitability  of 
the  system  less  alive  to  impressions  there?  Surely  not.  Since 
then  these  vicissitudes  in  feeling  are  found  to  be  so  preju- 
dicial to  the  morbid  constitution  on  land,  we  may  natu- 
rally conclude  that  they  exert  no  less  unwholesome  effects 
on  the  debile  system  at  sea.  I  have  been  much  at  sea,  and 
am  a  strong  advocate  for  the  use  of  sea-voyages  in  medi- 
cine. I  kno'Uf  their  efficacy,  for  I  h^ve  been  an  eye-witness 
to  their  power  in  relieving  those  who  were  beyond  the  reach 
of  medicine.  I  have  seen  the  last  scintillating  light  of  life, 
fanned  into  a  bright  and  burning  flame,  by  means  of  this 
mighty  influence;  but  I  would  yet  discourage  the  too  hasty 
recourse  to  this  remedy.  I  know  it  has  done  good,  I  believe 
it  may  do  harm.  In  speaking  as  I  have  done  respecting  the 
dejection  of  mind  that  a  sea-voyage  sometimes  produces,  I 
am  not  ignorant  that  highly  respectable,  nay  celebrated  au- 
thors have  maintained  a  contrary  opinion.  With  deference  I 
have  ventured  to  oppose  the  powerful  current  that  flows 
against  me;  and  I  can  only  say  that  what  I  have  advanced  is 
grounded  upon  a  strict  and  unwearied  attention  to  the  ef- 
fects of  the  sea  life  upon  all  those  with  whom  from  time  to 
time  I  have  sailed.  I  have  been  for  months  together  at  sea 


71 

enough  for  the  purpose,  should  pursue  the  more 
agreeable  path,  and  travel  by  land.  To  others  whose 
limited  pecuniary  resources,  and  completely  enerva- 
ted constitutions  deprive  them  of  that  choice,  a  re- 
medy not  less  efficacious  is  held  forth,  by  means  of 
a  sea- voyage. 

Lastly,  a  question  yet  remains:  when  it  is  deemed 
convenient  to  make  a  change  of  climate,  what  places 
are  the  most  proper  for  the  purpose?  With  regard  to 
the  advantages  or  disadvantages  of  different  places,  I 
shall  not  venture  to  state  any  thing  positively,  for  in 
fact  I  am  very  little  conversant  in  these  things.  How- 
ever, this  much  1  may  say  with  certainty,  that  a  clear, 
dry,  and  at  least  in  most  cases,  an  uniform  climate,  is 
required.  The  southern  countries  of  Europe, — Spain, 
the  greater  part  of  Italy,  the  southern  parts  of  France, 
enjoy  such  a  climate;  so  also  does  Madeira,^^  and  the 
Bermuda  Islands.  It  is  my  intention  in  a  future  part 

with  four  hundred  and  once  with  near  five  hundred  souls. 
Among  such  a  number  I  could  not  fail  of  making  many  ob- 
servations, and  what  I  have  advanced  is  the  result  of  them. 


VI 


'»  It  was  formerly  very  common  for  physicians  who  ad- 
sed  a  change  of  climate  for  the  purpose  of  relieving  their 


/' 


of  this  work,  to  say  a  few  words  on  the  use  which 
the  physician  can  make  even  of  the  hottest  climates, 
with  a  view  to  their  remediate  eflfects  in  diseases. 

These  things  being  premised,   I  may  now  treat 
more  in  detail  of  certain  disorders  arising  from  our 

consumptive  patients,  to  send  them  to  the  island  of  Madeira. 
The  high  opinion  entertained  of  the  salubrity  of  that  place, 
will  appeal  from  the  following  passage  from  Dr.  Fothergiii's 
observations  on  consumptions.*  "  Of  all  the  places  we  are 
acquainted  with,  perhaps  the  island  of  Madeira  enjoys  the 
most  equal  temperature;  but  the  voyage  and  other  circum- 
stances attending  it,  afford  very  formidable  objections;"  and 
Dr.  Thomas  Reid,  in  the  first  edition  of  his  valuable  work  on 
pulmonary  consumption,  recommends  Madeira  in  preference 
to  Lisbon,  "  as  being  at  a  greater  distance,  more  to  the  south- 
ward, and  the  air,  from  its  insular  situation,  purer  and  infi- 
nitely more  healthy."  In  the  second  edition  of  his  work, 
however,  Dr.  Reid  tells  us  that  the  recommendation  of  Ma- 
deira as  above  stated,  was  made  on  the  authority  of  a  medi- 
cal friend  who  had  sent  phthisical  patients  to  that  island  with 
success,  as  well  as  in  consequence  of  what  Dr.  Fothergill 
had  said  respecting  it;  but  tells  us  that  having  subsequently 
made  some  inquiries  on  the  subject,  he  "  was  not  a  little 
surprised  to  hear,  that  it  (the  island  of  Madeira)  was  believ- 

•  Med.  Obser.  and  Inquir.  Vol.  V.  p.  368.  Ann.  1776. 


?3 

climate.  It  is  by  no  means  my  intention  to  descant 
upon  all  the  diseases  emanating  from  this  source.  It 

ed  to  be  particularly  prejudicial  to  the  consumptive."  He 
quotes  a  letter  from  Dr.  Gordon  of  Madeira,  dated  28th 
April,  1784,  in  answer  to  his  inquiries,  with  a  view  to  as- 
certain the  truth.*  Since  this  place  still  retains  the  reputa- 
tion of  being  peculiarly  suitable  for  consumptive  patients, 
with  some  physicians:  and  since  to  my  knowledge  a  few  pa- 
tients! have  been  sent  from  this  country  to  that  island,  who 
died  there,  it  may  not  be  amiss  to  publish  this  extract,  for 
the  information  of  those  who  may  be  disposed  to  follow  the 
same  practice.  Such  observations  as  this  letter  contains, 
coming  as  they  do  from  a  physician  residing  in  the  island, 
a  physician  too  of  reputation,  and  enjoying  the  confidence  of 
some  of  the  first  medical  men  of  London  at  that  time:  must 
be  read  with  interest,  and  cannot  fail  to  receive  the  attention 
they  merit. 

"  Sir  John  Pringle,  and  some  others  of  my  medical  ac- 
quaintance in  London,  did  me  the  honour  about  eight  or 
nine  years  ago,  to  send  some  of  their  consumptive  patients 
under  my  care,  of  which  few  recovered;  and  I  was  induced 
to  discourage  them  from  sending  any  more  to  our  island, 
especially  as  the  generality  of  these  cases  are  in  the  last 


*  Reid  on  Consumption.  2d  Edit.  p.  271. 

\  Two  from  Philadelphia,  and  one  from  Virginia, 

K 


74 

will  be  sufficient  to  take  into  consideration  those  in 
^rhich  a  change  of  climate  avails  most,  and  the  dan- 
ger and  inconvenience  of  which  particularly  demand 
the  assistance  of  this  remedy. 

The  diseases  which  may  be  ascribed  to  the  effects 
of  our  climate,  vary  according  to  the  age  of  the  per- 

stage  of  the  disease  before  they  leave  Britain.  And  unless 
they  are  particularly  recommended  to  some  British  mer- 
chant's house,  they  have  no  alternative,  but  to  take  up  their 
quarters  in  a  publick-house,  which  are  very  indifferent  in  this 
place,  and  by  no  means  calculated  for  their  reception.  No 
pecuniary  consideration  whatever  will  induce  the  natives  to 
accommodate  phthisical  patients.  Our  provisions  in  general 
are  not  bad,  though  it  is  often  difficult  to  procure  proper 
diet  for  the  valetudinarians,  by  having  no  kind  of  market 
established.  Our  roads  all  over  the  island  are  very  indif- 
ferent, and  not  shaded.  The  society  is  very  good  for  those 
in  health.  A  great  scarcity  of  asses  milk,  and  no  such  thing 
as  nurses,  or  proper  people  to  attend  the  sick.  Add  to  all 
these  objections,  I  am  of  opinion,  that  our  air  is  too  fine  and 
fienetrating  for  hectic  complaints^  and  should  imagine  the 
south  of  France  a  much  better  climate,  or  even  the  High- 
lands in  some  of  our  West  India  isles.  Am  sorry  the  situa- 
tion of  Madeira  will  not  permit  me  to  give  you  better  en- 
couragement on  the  propriety  of  sending  consumptive  pa- 
tients here." 


75 

son  affected.  Diseases  of  the  breast,  principally  hae- 
moptysis, and  pulmonary  consumption  which  often 
supervenes  upon  it,  occur  for  the  most  part  in  youth. 
In  more  advanced  age  these  complaints  are  rarely 
observed,  when  various  affections  of  the  abdominal 
viscera,  and  especially  of  the  stomach,  succeed.  Gout 
and  hypochondriasis  are  frequently  produced  by  these 
affections,  and  sometimes  they  are  found  combined 
with  them.  In  the  decline  of  life  when  all  the  powers 
of  the  system  have  become  degenerated,  the  intem- 
perate climate  falls  upon  those  already  debilitated  and 
nearly  worn  out  by  old  age, — racks  every  part  of  the 
system  with  innumerable  pains,  embitters  life,  and 
accelerates  the  approach  of  death.  It  is  my  intention 
in  the  following  pages  to  observe  the  natural  order  of 
diseases;  and  therefore,  I  ought  to  begin  with  pul- 
monary consumption,  which,  for  the  most  part,  oc- 
curs in  youth. 


76 


SECTION  IL 


Of  the  nature  and  symptoms  of  Pulmonary  Consumption,  and 
its  similarity  or  identity  with  Scrophula. — Of  the  different 
-tiotions  of  physicians  respecting  the  curableness  and  in- 
curableness  of  genuine  Phthisis. — Of  the  effects  of  Wounds 
and  other  Injuries  of  the  Lungs,  on  that  Viscus. — Of  the 
remote  and  proximate  causes  of  Consumption,  and  the  rea- 
sons that  may  be  deduced  from  them,  in  favour  of  a  change 
of  Climate  upon  the  Disease. — Of  the  curative  effects  of 
Travelling,  Riding  on  Horseback  and  Sea-Voyages. 

There  is  perhaps  no  disease  generated  in  this 
island,  whether  we  behold  its  devastations  or  those 
subjected  to  its  ravages,  more  deserving  of  attention 
than  pulmonary  consumption.  If  we  may  credit  the 
London  bills  of  mortality,  a  fourth  part  of  our  popula- 
tion is  carried  off  by  consumption."  This  prodigious 

17  «  In  the  London  bills  of  mortality,  the  number  said  to  die 
of  consumptions,  is  generally  between  four  and  five  thousand 
annually;  exclusive  of  those  not  buried  in  parochial  church- 
yards, and  in  every  other  part  of  the  kingdom.  Though  the 


77 

destruction  of  the  human  race  falls  especially  upon 
the  youth,  often  on  the  most  beautiful,  particularly  of 

manner  of  forming  these  registers,  is  liable  to  such  uncer- 
tainty, as  calls  loudly  for  reformation;  and  the  term  consump- 

0 

tion  is  applied  to  many  different  diseases;  yet  it  will  serrc 
to  demonstrate,  that  a  great  number  yearly  die  of  this  dis- 
ease. 

«  By  a  register  of  the  parish  of  Holy  cross  in  Salop,  from 
the  year  1770  to  1780,  kept  by  the  Rev.  Mr.  William  Gor- 
such,  it  appears,  that  three  hundred  and  eleven  died  in  the 
ten  years  by  disease  and  casualties;  out  of  which  sixty-two 
died  of  consumption;  sixty-four  of  a  natural  decay,  without 
any  apparent  distemper,  and  thirteen  by  accidents.  So  that 
the  deaths  by  consumption  are  somewhat  more  than  one  in 
four.  By  an  actual  survey  made  in  the  year  1780,  the  inha- 
bitants were  eleven  hundred  and  thirteen.  Philosofih.  Trans, 
vol.  72,  for  1782."* 

It  will  appear  from  the  above  account  of  the  bills  of  mor- 
tality of  the  city  of  London,  that  the  fatality  of  phthisis  is 
prodigiously  extensive;  and  from  what  has  been  advanced  in 
the  text,  that  the  disease  is  endemial  to  the  climate  of  Great 
Britain.  Now  it  is  a  fact  that  the  prevalence  and  fatality  of 


Reid  on  Consumption,  p.  yii. 


78 

the  fair  sex,  and  on  those  who  are  conspicuous  for  wit 
and  the  elegancy  of  their  minds  and  persons.  Should 

consumption  in  some  portions' jf  the  United  States  is  no  less 
conspicuous  and  demonstrable  than  in  England.  Volney  ob- 
serves that  «  all  travellers  in  the  United  States  have  spoken 
of  the  frequency  of  this  fatal  disease,  which  cuts  off  chiefly 
young  married  women  and  girls  in  the  flower  of  youth  and 
beauty.  It  is  more  common  in  New  England  and  the  middle 
states,  than  in  the  states  to  the  south-west."* 

Dr.  Spalding,  in  his  bills  of  mortality  drawn  up  at  Ports- 
mouth in  New  Hampshire,  has  proved,  that  as  great  a  num- 
ber of  persons  die  of  consumption,  in  a  given  time  and  in  a 
given  population,  in  the  New  England  states,  as  die  from 
malignant  fevers  in  the  southern  states  of  Carolinas  and 
Georgia.  What  then  is  the  probable  cause  of  this  great  pre- 
valence of  pulmonary  consumption  in  these  states?  I  have 
before  (Note  2)  hinted  at  the  similarity  of  our  climate  to 
that  of  Great  Britain,  and  said  that  a  corresponding  simili- 
tude in  the  constitution  of  the  endemial  diseases  might  rea- 
sonably be  expected  to  prevail.  Let  us  now  take  a  more 
extensive  view  of  the  nature  of  this  climate  with  regard 
to  the  probable  light  it  may  throw  on  the  cause  of  the  dis- 
ease as  above  stated.  And  first  let  me  remark  that  the  un- 
healthiness  of  the  countries  adjacent  to  our  lakes,  as  well  as 

*  Volney*s  View  of  the  Climate  and  SoU  of  the  United  States,  p.  280. 


79 

any  one  however  be  disposed  to  doubt  that  such  a 
deplorable  loss  can  arise  from  the  ravages  of  a  single 

of  some  of  our  eastern  sea  ports,  lying  exposed  to  the  sea 
blasts,  seems  to  be  in  opposition  to  the  notion  of  Sir  John 
Pringle,  who  conjectured  that  "  great  bodies  of  water,  such 
as  seas  and  lakes,  are  conducive  to  the  health  of  animals  by- 
purifying  and  cleansing  the  air  contaminated  by  their  breath- 
ing in  it."* 

There  is  no  doubt  that  the  different  complexion  of  the 
diseases  of  the  New  England  states,  from  those  of  the 
southern,  is  owing  chiefly  to  the  rigour  of  the  climate,  ac- 
companied by  rapid  and  unexpected  changes  of  the  weather. 
These  changes  of  course  are  ushered  in  by  variations  in  the 
winds.  In  the  state  of  Vermont  for  example  they  are  gene- 
rally from  the  south-west  to  the  north-east,  and  the  most 
prevalent  winds,  according  to  Williams,!  are  either  "  paral- 
lel with  or  perpendicular  to  this  course."  He  further  states 
that  there  the  west  and  north-west  winds  are  dry,  cooling  and 
clastick,  while  those  from  the  south  and  south-west  are  more 
warm,  moist  and  relaxing.  In  the  sudden  changes  then  of  winds 
possessing  such  different  properties,  we  will  find  a  fruitful 
source  of  colds  and  catarrhs,  the  forerunners  of  consumption. 

What 


*  Anniversary  Discourse  before  the  Boyal  Society,  in  the  yetr  1773. 
f  History  of  Verraontj  p.  48. 


80 

disease,  let  him  inspect  the  bills  of  mortality  of  the 
city  of  London.  Even  supposing  their  calculations 

What  has  been  just  said  respectmg  the  climate  and  winds 
of  the  state  of  Vermont,  is  true,  generally,  of  all  the  northern 
and  eastern  states.  Yet  so  versatile  is  the  constitution  of  the 
climate  of  this  country,  that  it  is  almost  impossible  to  de- 
fine, by  any  positive  language,  its  general  character.  This 
diversity  is  not  confined  to  any  particular  state,  or  tract  of 
country,  but  is  frequently  evidenced  in  different  parts  of  the 
same  state,  and  in  the  same  latitude.  To  understand  then  tho- 
roughly the  nature  of  the  American  climate,  one  ought  to  be 
able  to  view  it  in  all  its  multifarious  changes  throughout  the 
continent.  In  general  it  has  been  remarked  that  in  our  win- 
ters, when  a  steady  cold  prevailed  from  Christmas  till  March, 
with  much  snow  and  little  thaw,  and  uniformly  cold  elastick 
winds:  but  little  tendency  to  disease  was  observable;  and  the 
diseases  occurring  during  such  a  state  of  the  weather,  were 
manageable.  In  a  variable  winter  however,  when  a  warm 
mid-day  sun  and  rapid  thaws  are  generally  succeeded  by  the 
nipping  frosts  of  night,  and  particularly  when  much  rain 
falls:  colds  are  very  rife,  and  consequently  consumptions 
follow.  The  greatest  danger  in  this  climate  however,  is  to  be 
feared  in  the  months  of  spring.  This  is  a  deceitful  season, 
and  never  fails  to  make  unperceivcd  and  deadly  inroads  on 
the  constitutions  of  persons  predisposed  to  phthisical  com- 
plaints. Volney  has  asserted  that  "  throughout  the  continent 


81 

are  double  what  they  should  be,  how  extensive  and  in- 
deed lamentable  a  destruction  of  the  human  race, 

of  North  America,  there  is  no  spring.'"*  This  assertion,  no- 
vel as  it  may  at  first  sight  seem  to  be,  is  really  well  founded. 
There  is  no  part  of  the  United  States  north  of  the  state  of 
Maryland,  where  three  hours  fair  weather  may  be  depended 
on,  in  the  months  of  March  and  April;  and  though  Mayf  is 
less  variable,  yet  its  excessive  heats,  and  sometimes  unsea- 
sonable frosts,  render  it  so  unpleasant  a  month  generally, 
that  it  can  hardly  be  considered  as  spring  weather.  Compara- 
tively with  Europe,  according  to  M.  Volney,|  there  falls 
"  more  rain  in  the  United  States,  generally  speaking,  in 
fewer  days,  and  there  are  fewer  cloudy  days,  more  fair  days,§ 

*  On  the  Climate  and  Soil  of  the  United  States,  page  i£K). 

f  "  The  month  of  May,  1786,  will  long  be  remembered,  for  having  fur- 
nished a  very  uncommon  instance  of  the  absence  of  the  sun  for  fourteen  days, 
and  of  constant  damp  or  rainy  weather.'*  Rush's  Account  of  the  Climate  of 
Pennsylvania. 

+  View  of  the  Climate  and  Soil  of  the  United  States,  p.  24i,  242,  243. 

§  **  The  climate  of  much  the  greater  portion  of  the  United  States  furnishes 
great  degrees  of  heat  and  cold,  in  their  respective  seasons;  but  neither  of  the 
extremes  is  of  long  continuance.  Our  climate  is  also  very  variable,  the  tem-t 
perature  of  the  atmosphere  being  liable  to  great  and  sudden  vicissitudes.  Ne- 
vertheless, taking  the  whole  routine  of  the  seasons,  we  enjoy  a  large  pro- 
portion of  fine  and  moderate  weather,  -with  more  days  of  stm-shine  and  serene 
sky,  than,  perhaps,  any  part  of  Europe  exhibits." — Observations  on  the 
duration  of  Human  Life,  &c.,  in  a  letter  from  Wm.  Barton,  Esq.,  to  Dr.  Bit- 
tenhouse.  Trans.  Am.  Phil.  Soc.  Vol.  3.  p.  51,  paper  No.  vii. 


L 


V 


\ 


82 

•V 

must  we  not  attribute  to  pulmonary  consumption!  If 
it  was  worth  the  trouble  of  an  accurate  computation, 

and  more  evaporation.***  It  is  owing  to  this  powerful  evapo- 
ration in  the  United  States,  that  we  have  such  heavy  dews, 
which  are  unknown  in  the  temperate  climates  of  Europe. 
The  reason  of  this  rapid  evaporation  M.  Volney  believes  is 
«  because  the  winds  are  pure,  in  consequence  of  the  general 
plainness  of  the  surface,  and  because  one  of  them,  the  north- 
west, which  is  extremely  dry,  prevails  for  two-fifths  of  the 
year.**t  Hence  we  have  another  cause  for  the  prevalence  of 


*  Mr.  J.  (now  General)  Williams*  found  by  a  series  of  experi- 
ments and  researches  that  the  mean  quantity  of  evaporation,  at  Cam-    Inches. 
bridge,  near  Boston,  for  a  term  of  seven  years,  was  -        -        -    36 

While  in  seven  German  and  Italian  cities,  on  a  mean  of  twenty 
years,  it  was  only      --- 49 

Which  leaves  a  difference  of-- 7 

Yet  the  cities  of  Italy  are  in  a  latitude  much  more  favourable  to  evaporation 
than  the  vicinity  of  Boston,  adjacent  to  the  Atlantic  Ocean. 

Fair  Days. 

In  one  year  there  were  at  Salem 173 

At  twenty  cities  in  Europe      -        : 64 

'  ■  Cloudy  Bays. 

At  these  same  twenty  cities  there  were  in  1785  -        -        -  113 

At  Cambridge,  near  Boston -        -        -      69 

At  Salem,  taking  the  medium  of  seven  years      -        -  '     -        -  9l> 


t  View  of  the  Climate  and  Soil  of  the  United  States,  p.  244. 


Transactions  of  the  American  Phil.  Soc. 


83 

it  would  not  be  in  the  least  difficult  to  show,  that 
twenty-five  thousand  men  are  annually  destroyed   in 

consumption.  The  warm  mid-day  suns  produce  copious  per- 
spiration in  the  spring,  and  the  sudden  evaporation  of  it  pro- 
duces catarrhs.  The  air  of  America  abounds  more  in  electrick 
fluid  than  that  of  Europe;  this  fact,  which  evidences  an  exces- 
sive dryness  of  the  air,  and  which  really  is  only  observable  dur- 
ing the  continuance  of  the  dry  and  healthy  winds,  is  remark- 
ably demonstrated  in  the  appearance  of  the  silk  tassels  worn 
on  boots,  especially  when  they  come  frequently  in  contact 
with  the  silk  linings  of  our  surtouts.  It  is  constantly  observed 
too,  flying  off*  in  sparks,  when  we  pull  off  worsted  or  silk 
stockings. 

When  the  atmosphere  is  thus  surcharged  with  electrick 
fluid,  it  is  highly  salutary.  Every  degree  of  diminution  in 
the  quantity  of  this  fluid,  is  an  evidence  of  an  increased  de- 
gree of  dampness  in  the  air,  and  consequently,  argues  a  less 
wholesome  quality  in  it.  The  changes  from  this  state  of  air 
to  excessive  humidity,  are  very  common,  and  not  unfre- 
quently  very  sudden.  Hence  a  reason  why  we  should  guard 
against  the  colds  consequent  to  them,  by  changing  or  in- 
creasing the  quantity  of  our  clothing.  The  female  portion 
of  the  population  of  the  middle  and  northern  states,  is  said 
to  be  more  subject  to  consumption  than  the  male.  If  this  be 
actually  the  case,  and  I  am  inclined  to  believe  it  is,  we  need 
look  no  further  for  the  cause,  than  the  recklessness  with 


84 

Great  Britain  by  this  disease.  The  celebrated  Syden- 
ham advanced  an  opinion  respecting  this  malady,  not 

which  the  women,  and  young  girls,  particularly  those  ac- 
customed to  move  in  the  gay  circles  of  high  life,  indulge 
themselves  in  imprudent  changes  of  clothing.  This  is  at  all 
times  ill-proportioned  to  the  severity  of  our  climate;  and 
when  the  little  degree  of  comfort  and  protection  it  is  ca- 
pable of  affording,  is  wantonly  sacrificed  at  the  shrine  of 
fashion,  need  we  be  surprised  to  hear  the  reiterated  com- 
plaints of  colds  they  make;  or  can  we  doubt  the  assertion, 
that  this  sex  is  peculiarly  liable  to  phthisical  complaints. 
This  last  circumstance  is  said  by  M.  Volney  to  be  owing 
to  their  "  light  and  airy  dress."  He  says  that  in  the  course  of 
two  winters,  he  observed  a  great  number  of  people  of  fashion 
had  four  or  five  relapses,  "  for  the  rich  are  particularly  lia- 
ble to  colds."*  "  In  the  cities  on  the  coast,"  he  continues, 
"  where  the  people  are  eager  to  imitate  Europeans,  these 
colds  have  other  causes  in  overheated  apartments,  balls,  tea- 
parties,  and  feather  beds;  sometimes  indeed  in  the  German 
fashion,  that  is,  a  feather  bed  to  sleep  on,  and  another  as  a 
coverlid." — The  circumstance  above  stated,  respecting  the 
greater  prevalence  of  colds  among  people  of  fashion,  (for 
such  I  presume  M.  Volney  alludes  to  when  he  says  « th6 
rich,")  is  a  notorious  fact;  and  among  these,  there  is  no 


*  Volney's  View,  ke.  p.  279  and  280. 


85 


widely  differing  from  this;  namely,  that  two-thirds 
of  those  that  fall  victims  to  chronick  diseases,  arc 

doubt  that  the  women  are  more  frequently  afflicted  than  the 
men.  It  is  a  fact  as  notorious  too,  that  it  is  a  common  prac- 
tice among  the  young  girls  of  this  and  other  cities,  to  throw 
off  a  flannel  garment  which  they  have  worn  all  day  in  the 
house,  and  in  a  warm  room,  when  they  go  to  a  dance  or 
tea-party  in  the  evening.  This  circumstance*  of  itself  would 
be  a  fruitful  source  of  consumption,  in  such  a  climate  as 
this:  but  when  we  add  to  it  the  thin  and  scanty  dress  which 
supplies  its  place, — the  imprudent  exposure  to  the  cold  air 
while  in  profuse  perspiration  after  dancing,  and  what  has 
equally  an  injurious  effect,  the  thoughtlessness  of  eating 
ice-creams  while  overheated  by  this  violent  exercise,— ought 
we  not  rather  to  be  surprised  that  consumption  does  not 
sweep  away  the  fairest  portion  of  our  population  entirely, 
than  doubt  the  verity  of  the  assertion:  that  women  and  young 
girls  in  the  United  States  are  more  liable  to  consumptions 
and  colds,  than  any  other  persons?  If  then  this  change  of 
clothing,  this  imprudent  exposure  while  so  thinly  clad;  and 


*  '*  A  learned  author  supposes  the  imprudent  changing  of  garment  destroys 
more  than  the  plague,  famine,  or  the  sword;  one  would  think  the  ladies 
dressed  in  those  days  as  now;  wrapping  themselves  up  in  the  day,  and  ex- 
posing their  persons  to  the  cold,  damp  night-air."— Thos.  Reid  on  Consump- 
tion, p.  394. 


86 

carried  off  by  pulmonary  consumption.  In  another 
place  he  asserts  that  chronick  diseases  destroy  almost 

this  more  than  imprudent  exposure  while  overheated  by- 
warm  rooms  and  dancing,  are  sufficient  to  produc  e  such 
evils  in  this  delicate  sex — what  fatal  danger  must  they  not  ex- 
pose themselves  to,  by  encountering  all  these  hazardous  cir- 
cumstances at  particular  times,  when  the  constitutional  econo- 
my requires  infinitely  more  care  than  during  the  interval  of 
these  periods:  and  when  the  system,  even  of  the  most  ro- 
bust female,  is  always  more  or  less  debilitated  and  disor- 
dered! 

From  the  foregoing  observations  therefore,  it  follows:  that 
the  cause  of  the  prevalence  of  consumption  in  some  portions 
of  the  United  States  is  to  be  found  in  the  inconstant  state  of 
the  climate  as  demonstrated  in  the  sudden  and  excessive 
transitions  of  the  weather;*  the  great  evaporation  and  heavy 


*  The  range  of  the  thermometer  in  these  states,  is  not  unfrequently  from 
80**  of  Fahrenheit  in  summer  to  zero,  or  one  or  two  degrees  below  it,  in 
winter.  And  in  the  present  month,  (Feb.  1815,)  the  mercury  stood  at  from 
5**  to  16®  below  zero  of  Fahrenheit  in  different  parts  of  the  United  States. 
My  father  mentions,  that  "  Mr.  Rittenhouse  had  noticed,  that,  at  his  Norriton 
observatory,  (in  lat.  40"  9'  31"  N.)'the  mercury  in  Fahrenheit's  thermometer, 
not  exposed  to  the  sun-shine,  but  open  to  the  air,  was  at  941  30',  on  the  5tli 
of  July,  1769;  *  which,'  says  he,  '  was  the  greatest  height  it  had  ever  been  ob- 
served to  rise  to,  at  that  place.'  But  the  wnter  is  informed  by  a  judicious  and 
attentive  observer,  that  at  Lancaster,  Pennsylvania,  w^hich  is  in  lat.  40«  2' 
39''  N.  (the  long,  of  this  borough-town  is  5»  1'  4"  W.  from  Greenw.)  the 
mercuiy  rose  by  Fahrenheit's  scale,  on  the  7th  of  July,  1811,  to  97*  30'. 
Admitting  this  to  be  correct,  if  1»  30'  be  then  deducted,  for  the  extra  heat  of 


87 

a  third  part  of  mankind.  From  these  proportions  as 
data,  it  would  appear  that  pulmonary  consumption  de- 
stroys forty  thousand  men  and  more,  annually  in  this 
island.  There  is  however,  no  occasion  to  descant  upon 
the  devastations  of  this  malady.  For  there  are  few  of 
us,  who  have  not  to  lament  the  death  of  acquaintances, 

dews  which  follow  it;  the  frequency  of  checked  perspiration 
by  cold  winds  after  rapid  thaws  of  snow;  the  disproportioned 
quantity  of  clothing  at  all  times,  particularly  of  the  females, 
to  the  rigour  of  the  climate,  and  the  imprudent  change  of  it 
during  the  winter  season;  as  well  as  the  careless  exposure  of 
the  system  to  the  intemperance  of  the  spring  weather,  by  the 
premature  alteration  of  winter  dress,  particularly  the  imprudent 
change  of  flannel  garments.  Among  these  causes,  it  is  evident 
that  the  physical  constitution  of  the  country  has  a  most  power- 
ful operation,  yet  it  is  equally  plain  that  the  defects  of  climate 
are  assisted  in  their  unhealthy  consequences,  by  the  artificial 
deficiencies  in  clothing.  This  proves  that  with  greater  atten- 
tion to  the  state  of  the  weather,  and  more  care  in  adapting  the 
the  covering  of  our  bodies,  to  its  inclemencies  and  its  ea- 
pricies:  the  prevalence  of  this  destructive  disease  would  be  in- 
finitely diminished,  and  in  all  probability  its  violence  and  fatality- 
lessened. 


so  large  a  town  as  Lancaster  in  comparison  with  a  country  situation,  there  is 
in  this  case  the  great  range  of  118"  by  Fahrenheit's  scale,  for  the  extremes 
of  heat  and  cold  in  Pennsylvania." — Barton's  Memoirs  of  Kittenhouse,  note, 
p.  13f^. 


88 

associates,  or  friends,  who  have  been  snatched  from 
us  by  this  destructive  complaint.  Relentless,  cruel 
and  unfeeling — this  deadly  consumer  of  human 
health,  glutting  itself  perpetually  upon  the  young 
and  delicate,  fills  our  country  with  sorrow  and  de- 
vastation! 

Pulmonary  consumption  is  esteemed  an  endemial 
disease  in  our  climate,  and  not  improperly;  for  per- 
haps there  is  no  country  on  the  globe  in  which  it 
produces  such  fatality.  All  physicians  confess  that 
the  most  efficient  remedies  are  administered  in  this 
disease  in  vain,  at  least,  in  the  generality  of  cases; 
and  that  when  it  is  of  long  standing,  a  radical  cure 
must  be  despaired  of.  The  cure  even  of  incipient 
phthisis,  is  a  precarious  and  difficult  undertaking. 
No  remedy  succeeds  better  in  this  disease  than  a 
change  of  climate,  by  means  of  a  seasonable  journey 
into  warm  countries.  Whatever  therefore  seems  to 
promise  any  assistance  in  so  dangerous  a  malady, 
is  worthy  of  the  highest  attention.  Its  mode  of  action 
is  now  to  be  investigated.  By  an  attention  to  the 
symptoms,  and  to  the  remote  and  proximate  causes 
of  the  disease,  as  well  as  from  analogy  of  those  things 
which  have  the  effect  of  yielding  succour  to  the  ma- 


S9 

lady,  we  may  learn  how  that  remedy  operates  bene- 
ficially. 

Pulmonary  consumption  may  be  known  for  the 
most  part,  by  the  following  symptoms:  a  slow  ema- 
ciation of  the  whole  body,  accompanied  with  hcctick 
fever;  a  sense  of  weight  or  constriction,  or  pain,  in 
the  breast,  with  difficulty  of  breathing;  a  frequent 
and  troublesome  cough,  which  in  the  beginning  is 
dry,  but  after  the  disease  has  progressed,  generally 
accompanied  with  purulent  spitting.  The  symptoms 
which  denote  incipient  consumption,  vary  according 
to  the  causes  which  produce  it,  as  for  instance,  pleu- 
risy, catarrh,  haemoptysis,  &c.  The  proximate  cause 
of  this  disease  is  well  known.  Dissections  of  the  bo- 
dies of  persons  who  have  died  of  consumption,  have 
almost  always  exhibited  tubercles,  vomicas  and  ul- 
cerations of  the  lungs,  by  which  sometimes  nearly 
the  whole  of  that  viscus  is  consumed.  I  say  that 
these  morbid  phaenomena  will  almost  always  occur, 
for  I  would  not  venture  to  assert  that  they  will  al- 
ways be  found.  There  are  many  physician^^  of  no  little 
reputation,  who  strenuously  contend,  that  sometimes 
neither  an  ulcer  nor  any  other  visible  injury  is  to  be 
discovered  in  the  lungs  of  those  who  have  had  co- 

M 


90 

pious  purulent  spitting,  and  other  symptoms  of  con- 
sumption, and  who  had  evidently  died  of  this  disease. 
It  is  agreed  on  all  hands  however,  that  instances  of 
this  kind  are  very  rare,  while  it  is  generally  allowed 
that  true  consumption  arises  from  an  ulcer,  or  rather 
ulcers  in  the  lungs.  The  dissections  indeed  of  dead 
bodies  satisfactorily  demonstrate,  that  not  only  a  sin- 
gle ulcer  or  tubercle,  but  sometimes  congregations 
of  them  had  produced  the  disease,  and  that  these  had 
become  inflamed  and  had  suppurated.  The  proxi- 
mate cause  therefore  being  known,  the  curative  in- 
dication would  seem  to  consist  in  dissipating  the 
tubercles,  or  if  they  shall  have  already  passed  into  sup- 
puration, to  heal  the  ulceration  in  the  first  place.  This 
effect  however  is  to  be  accomplished  by  the  healing 
powers  of  nature,  and  not  by  the  assistance  of  phy- 
sicians; and  I  must  confess  that  in  this  stage  of  the 
disease  I  see  nothing  which  justifies  the  expectation 
of  any  benefit  being  likely  to  result  from  a  change  of 
climate.  If  the  general  habit  of  body  is  sound,  ulcers 
in  any  other  part  are  usually  healed  with  facility  by 
the  mere  efforts  of  nature;  and  in  such  cases  physi- 
cians might  easily  retard,  though  they  could  scarcely 
promote,  the  cure.  For  I  do  not  know  any  reme- 
dies which,  by  any  specifick  power,  can  produce 


91  > 

that  healing  process.  It  is  well  known,  that  many  re- 
medies which  have  been  administered  ^vith  that  in- 
tention, have  had  altogether  a  contrary  effect,  and 
not  only  did  not  do  any  good,  but  often  proved  very 
injurious, — such  as  natural  and  artificial  balsams:  and 
these  are  now  rarely  employed. 

Yet  there  are  certain  indolent  ulcers,  which  re- 
quire the  assistance  of  the  physician  and  the  surgeon; 
and  many  ulcers  that  do  not  heal  spontaneously,  arc 
easily  cured  by  the  administration  of  proper  reme- 
dies. By  analogy,  various  remedies  have  been  tried 
in  depraved  and  obstinate  ulcers,  consuming  the 
lungs.  Of  the  manner  in  which  the  remedies  that 
assist  the  cure  of  external  ulcers  act,  it  is  easy  to 
give  the  rationale.  They  divide  themselves  into  two 
classes: — into  external  and  local,  which  are  applied 
immediately  to  the  ulcer,  and  affect  that  only:  and 
into  internal  and  general,  which  act  upon  the  whole 
system,  and  do  good,  not  only  to  the  ulcer,  but  also 
remove  any  taint  pervading  the  general  system. 
The  first  are  of  the  greatest  utility  in  curing  that  par- 
ticular  state  of  ulcers,  which  from  experience  we 
know  retards  their  cure.  As  for  example,  incisions  or 
cscaroticks  for  destroying  fungous  flesh,  or  removing 
callous  parts,  or  inducing  a  new  and  favourable  sup- 


92  • 

puration,  which  are  evidently  required  in  healing  an 
ulcer.  But  it  is  impracticable  to  administer  reme- 
dies of  this  kind  in  consumption;  and  even  if  they 
could  be  employed,  I  know  of  no  symptom  by  which 
such  a  condition  of  the  ulcers  could  be  ascertained, 
so  that  either  one  or  other  of  these  remedies  could 
be  pointed  out  as  necessary. 

The  other  class  of  remedies  (to  wit,  the  general 
and  internal,)  exert  scarcely  less  power  in  curing 
those  ulcers  which  arise  from  some  general  taint.  Such 
are  the  syphilitick  or  scorbutick  ulcers,  which  for 
the  most  part  we  may  vainly  expect  to  heal  by  purely 
local  means,  unless,  at  the  same  time^  internal  and 
general  remedies  adapted  to  the  cure  of  those  dis- 
eases, are  carefully  administered.  By  analogy,  there- 
fore, in  this  malady,  arising  from  ulcers  difficult  to 
to  heal,  remedies  should  be  administered  for  curing 
that  taint,  of  whatever  sort  it  may  be,  which  impedes 
the  curing  of  such  ulcers.  In  order  properly  to  ac- 
complish this  purpose,  it  is  necessary  to  ascertain 
the  remote  causes  of  the  disease.  It  is  not  necessary 
to  expatiate  largely  on  the  subject,  to  show  that  con- 
sumption does  not,  at  least?  generally,  arise  from  a 
inere  injury  or  even  from  suppuration  of  the  lungs. 


93 

unless  some  morbid  predisposition  or  taint  shall  pre- 
viously have  existed  in  that  viscus,  or  in  the  general 
system.  What  that  taint  is,  will  hereafter  be  investi- 
gated. It  is  known,  however,  that  this  disease  gene- 
rally supervenes  upon  haemoptysis;  so  that  whenever 
a  young  person  is  aflected  with  a  spitting  of  blood 
from  the  lungs,  his  case  is  hopeless.  Sometimes 
also,  consumption  follows  a  badly  treated  peripneu  - 
mony  or  pleurisy  which  has  terminated  in  suppura- 
tion. Sometimes  too,  though  rarely,  it  arises  from 
some  great  external  violence,  inflicted  on  the  breast  or 
the  lungs  themselves.  These  things  having  been  ob- 
served to  take  place,  it  has  been  hastily  concluded, 
that  an  injury  and  a  certain  depraved  suppuration  of 
the  lungs,  as  well  as  an  incurable  ulcer,  and  conse- 
quendy  a  mortal  consumption,  were  produced.  Physi- 
cians have  referred  the  cause  of  this  injury,  to  the  na- 
ture and  construction  of  the  lungs,  and  their  office.  In 
support  of  this  opinion  they  have  remarked,  that  the 
blood  flows  with  great  force  through  the  lungs, 
and  that  they  themselves  are  agitated  by  a  perpetual 
motion,  namely  of  respiration,  which  by  alternately 
weakening  and  irritating  its  parts,  was  believed  to 
impede  the  cure  of  a  wound.  And  finally  they  have 
adduced  another  reason  from  the  analogy  of  external 


94 

wounds,  which  are  difficultly  cured  when  exposed  to 
the  air.  Now  the  air,  say  they,  is  received  into  all  i>arts 
of  the  lungs;  if  therefore  there  be  any  ulcers  there, 
they  are  necessarily  exposed  continually  to  it.  But  all 
these  circumstances  are  not  sufficient  to  solve  the  dif- 
ficulty. The  motion  of  the  individual  parts  of  the  lungs 
is  always  inconsiderable,  and  except  in  a  full  inspira- 
tion, scarcely  sensible.  It  seems  hardly  probable, 
therefore,  that  such  injury  should  arise  from  this 
cause.  And  no  effect  should  be  attributed  to  the  ad- 
mission of  air;  for,  although  it  is  received  into  the 
lungs,  it  never  comes  in  immediate  contact  with  them, 
since  the  internal  surface  of  this  viscus  is  always  lubri- 
cated with  mucus,  which  would  naturally  defend  any 
wound  from  the  air.  Besides,  we  know  that  the  exter- 
nal wounds  of  dogs,  and  many  other  animals,  heal  after 
being  licked;  for  this  very  reason,  that  the  saliva  and 
mucus  mixed  with  it,  sufficiently  defend  the  wounds 
from  the  action  of  the  air.  All  arguments  therefore, 
tending  to  show  that  an  injury  of  the  lungs  ought  to 
produce  consumption,  go  for  nothing.  And  besides, 
experience  proves  that  the  fact  is  not  so.  For  there 
are  innumerable  examples  of  cures,  where,  after  the 
most  manifest  injuries,  nay,  even  suppuration,  of  the 


95 

lungs,  no  consumption  ensued. ^^  Many  persons  also 
have  been  affected  with  haemoptysis,  without  con- 

^8  A  very  remarkable  instance  of  entire  recovery  from  a 
wound  into  tlie  cavity  of  the  lungs,  is  related  by  Dr.  May,*  of 
Plymouth,  in  England.  The  case  was  that  of  a  British  officer, 
who  was  wounded  in  a  duel.  The  pistol  ball  passed  in  the  di- 
rection of  the  right  lobe  of  the  lungs,  through  which  it  was 
supposed  to  have  perforated.  Considerable  external  haemor- 
rhage and  bloody  expectoration  with  difficulty  of  breathing 
came  on;  these  were  followed  by  a  cough  and  symptoms  of 
violent  inflammation.  The  antiphlogistick  plan  of  treatment 
was  pursued.  Blood  was  discharged  for  many  days  by  coughing, 
and  purulent  expectoration  supervened.  Symptoms  of  conva- 
lescence soon  after  appeared,  and  the  patient  in  a  short  time 
entirely  recovered.  Dr.  May  says  he  was  indebted  for  this  fact  to 
Mr.  Adams,  of  Likeard,  an  ingenious  surgeon  of  the  navy,  who 
was  an  eye  witness  of  the  circumstance.  That  the  ball  actually 
perforated  the  lungs  in  this  case,  was  proved  by  a  circum- 
stance which  subsequently  occurred.  A  piece  of  woollen 
cloth,  enveloped  in  a  clot  of  blood  and  pus,  was  brought  up  by 
coughing.  That  consumption  did  not  follow  seems  plain,  but 
in  all  likelihood  the  patient  owed  his  escape  from  it,  to 
a  circumstance  which,  though  no  mention  is  made  of  it,  in 
all  human  probability  really  existed:  I  mean  a  sound  and 
robust  constitution,  unblemished  by  any  latent  pulmonary 
taint.  I  am  the  more  inclined  to  this  opinion,  from  having  had 

•  Essay  on  Pulmonary  Consumption,  b)  Wm.  May,  M.  D.  Intror'.  p.  xiu. 


96 

sumption  supervening.  Many  ^fter  an  attack  of  badly 
treated  peripneumony,  have  had  an  extensive  suppu- 

under  my  own  care  a  case  strikingly  similar,  as  far  as  respects 
the  nature  of  the  wound,  though  followed  by  very  dissimilar 
results.  As  this  kind  of  wounds  of  the  lungs  is  always  inte- 
resting, I  will  briefly  relate  the  instance  I  allude  to,  which  1 
the  more  willingly  do,  as  perhaps  I  shall  never  have  another 
fit  opportunity  of  making  it  publick.  While  I  was  surgeon  of 
the  frigate  United  States,  in  the  year  1809,  being  on  shore  at 
Norfolk,  where  the  ship  was  then  stationed,  I  was  called  to 
visit  midshipman  L  h,  whom  I  had  but  an  hour  before  seen 
on  board,  in  perfect  health.  He  was  so  unfortunate  as  to  have 
been  under  the  necessity  of  meeting  a  brother  officer  in  the 
field.  »His  antagonist's  ball  (being  one  of  the  largest  pistol- 
size,  since  the  arms  used  were  ship*s  arms)  had  entered  the 
ieft  side  of  the  breast  and  had  passed  entirely  out  under  the 
inferiour  edge  of  the  scapula;  its  direction  being  obliquely 
upwards  and  backwards  from  the  point  where  the  ball  en- 
tered to  the  place  of  its  exit.  I  found  him  bleeding  pretty 
largely  from  the  external  wound  in  the  breast,  and  copiously 
expectorating  blood,  likewise  coughing  it  up  at  short  inter- 
vals, in  large  clots.  He  was  labouring  under  great  difficulty 
of  respiration,  and  at  times  seemed  nearly  to  be  suffocated 
with  the  rapid  and  extensive  internal  haemorrhage.  His  coun- 
tenance had  a  ghastly  paleness,  which,  together  with  the 
deadly  hue  of  his  lips,  and  other  symptoms,  seemed  to  in- 
dicate that  he  was  fast  approaching  dissolution.  It  is  needless 
to  go  into  the  detail  of  the  treatment  pursued.  Suffice  it  tosay* 


97 

ration  in  the  lungs,  which  being  entirely  rejected  by 
spitting,   was  soon   cured.  And  finally,   examples 

that  it  was  rig^orously  calculated  to  allay  the  great  irritation 
of  the  system  while  it  continued,  and  subsequently  modified 
and  altered  as  the  exigencies  of  the  case  required.  In  a  short 
time,  extensive  suppuration,  with  a  constant  cough  came  on, 
and  continued  for  a  long  time  to  weaken  the  patient.  Hectick 
fever  with  colliquative  night   sweats   now  succeeded,   and 
seemed  to  threaten  a  fatal  termination  to  the  life  of  this  inte- 
resting youth.  He  however  survived  the  accident,  a  circum- 
stance chiefly  owing  to  the  kind  and  close  attention  of  his 
brother  officers  of  the  ship,  whom  commodore  Decatur  per- 
mitted to  be  as  much  on  shore  to  nurse  and  watch  with  him, 
as  the  duty  of  the  ship  could  admit  of:  an  office,  as  he  was 
much  beloved,  that  they  all  cheerfully  performed,  and  in 
■which  they  showed  their  usefulness  by  a  prompt  and  correct 
execution  of  the  directions  of  his  medical  attendants.  In  the 
month  of  February,  1810,  the  United  States  proceeded  to  sea, 
and  Mr.  L.  was  s6nt  to  the  Marine  Hospital  under  the  care  of 
Dr.  Barraud,  who  showed  him  every  possible  attention  and 
kindness.  In  the  month  of  April,  1812,  while  visiting  the  navy- 
yard  at  Washington,  I  accidentally  met  him.  He  had  been 
with  his  friends  in  the  country,  and  his  general  health  was 
considerably  mended,  though  it  was  plain  to  me  that  he  la- 
boured under  a  pulmonary  affection.  He  is  still  living,  I  be- 
lieve, though  I  fear  he  will  never  shake  off  the  disastrous 
consequences    of    his   accident.    His   stature,    the    confof- 

N 


98 

daily  occur  where  the  lungs  are  injured  by  external 
violence,  or  wounded,  and  yet  consumption  rarely 
arises  from  these  causes.  If  the  wound  be  extensive, 
sudden  death  entirely  prevents  all  danger  of  con- 
sumption: if  it  be  slight,  it  is  soon  healed.  Indeed, 
there  is  one  instance  of  a  wound  in  the  lungs  proving 

mation  of  his  chest,  his  voice,  his  complexion,  even  in  health, 
strongly  indicated  I  think,  a  predisposition  to  phthisis.  Conse- 
quently no  one  will  be  surprised  to  hear  that  it  supervened 
eventually.  This  might  with  propriety  be  classed  with  the 
phthisis  ab  vulnere  of  Sauvage,  and  the  "  phthisic  par  bles- 
sure  de  poitrine"  of  Bonnafox  Demalet.*  Drs.  Barraud,  Sel- 
den  and  Hansford,  physicians  of  Norfolk,  saw  this  gentleman 
with  me  in  the  first  instance:  he  had  then  been  wounded 
about  half  or  three  quarters  of  an  hour.  The  two  first  and  my- 
self continued  to  see  him  for  two  weeks  or  more,  and  the 
latter  part  of  the  time  Dr.  Selden  and  myself  continued  in  at- 
tendance together.  The  case  of  this  young  man  is  well  known 
to  Dr.  Gerard  Dayers,  now  surgeon  of  the  Congress  frigate, 
and  Dr.  William  Clarke,  at  present  surgeon  of  the  Wasp 
sloop  of  war:  both  at  that  period  my  mates  on  board  the 
United  States. 


*  This  nosological  writer  places  this  variety  of  consumption,  as  the  sixtli 
species  of  the  third  genus  of  the  disease.  His  first  genus  contains  four  species; 
his  second,  ten;  his  third,  six. —  Vide  "  Traite  sur  la  nature  et  le  traUement  de 
la  Phthisic  Pulmonaire,"  by  this  author. 


99 

a  cure  instead  of  the  cause,  of , phthisis.  A  military 
commander  who  was  believed  to  labour  under  a  pul- 
monary consumption,  was  wounded  in  an  engage- 
ment, the  ball  having  passed  through  his  lungs. 
This  remedy,  a  harsh  and  dangerous  one  it  must  be 
confessed,  succeeded  most  happily;  and  the  man 
lived  many  years  afterwards,  and  is  yet  living,  free 
from  every  consumptive  symptom.  Consequently^ 
in  order  to  cure  a  suppuration  of  the  lungs,  there 
is  no  necessity  for  the  use  of  remedies  which  pro- 
mote directly  the  healing  of  the  ulcer  itself,  if  any 
there  be,  endowed  with  such  a  virtue.  And  we  see 
nothing  in  an  ulcer  of  this  nature,  requiring  a  change 
of  climate.  The  assistance  ofthe  physician  is  no  further 
necessary,  than  in  seeing  that  the  morbid  taint  which 
renders  the  ulcer  incurable,  whether  affecting  tlie 
lungs  only,  or  contaminating  the  general  system,  be 
first  removed:  when  that  is  banished,  the  ulcer  will 
be  easily  healed.  For  the  healing  powers  of  nature 
alone  effect  the  cure  of  an  ulcer  in  the  lungs,  as 
in  other  parts  of  the  body,  when  every  obstacle  is 
removed. 

All  these  facts  plainly  prove,  if  I  am  not  mistaken, 
that  a  simple  injury  of  tlie  lungs,  and  a  rupture  of 
their  vessels,  can  never  induce  an  incurable  ulcer 


100 

and  pulmonary  consumption,  unless  the  lungs  them- 
selves or  the  general  habit,  have  previously  become 
contaminated  by  some  taint.  But  the  nature  of  this 
predisposing  vice  can  only  be  ascertained  from  ob- 
servations  of  the  causes  of  the  disease.  Experience 
therefore  teaches  us,  that  those  persons  will  be  most 
liable  to  consumption,  who  have  received  an  here- 
ditary taint  from  their  parents;  who  are  between  the 
age  of  puberty  and  thirty-five  years;  who  have  a  deli- 
cate and  weak  habit,  a  contracted  and  narrow  chest, 
a  deformed  spine,  and  shoulders  projecting  dispropor- 
tionably  beyond  the  arms;  who  have  a  white  and 
smooth  skin  and  delicate  complexion,  long  neck, 
weak  voice,  and  frequent  hoarseness  from  slight 
causes,  together  with  a  sanguineous,  phlegmatick 
temperament:  and  finally,  those  in  whom  there  is  a 
scrofulous  and  hasmorrhagick  disposition,  and  who 
are  very  liable  to  catarrhs.  These  signs,  indeed,  give 
evidence  of  the  weak  habit  of  the  whole  system:  but 
especially  denote  a  mal-conformation  of  the  lungs. 
The  chief  and  most  frequent  causes  of  consumption, 
however,  if  I  am  not  mistaken,  may  be  reduced  to 
three;  to  wit:  a  scrofulous  disposition,  haemoptysis, 
and  catarrh.   From  whichever  of  these  the  disease 


101 

arises,  I  shall  endeavour  to  show,  that  a  change  oi" 
climate  promises  great  assistance. 

All  physicians  know  that  this  complaint  very  fre- 
quently arises  from  a  scrofulous  disposition.  The  illus- 
trious Mead  advanced  that  opinion  many  years  ago. 
Indeed,  we  owe  to  Sydenham  a  memorable  remark, 
which  seems  to  have  suggested  this;  namely,  that  in 
some  consumptive  persons  who  had  been  cured  by 
riding^on  horseback,  glandular  tumours  in  the  neck 
which  bore  a  strong  resemblance  to  scrofulous  swel- 
lings,  have  been  observed  after  that  disease  had  left 
them.  No  doubt,  however,  remains  on  this  subject 
among  physicians  of  the  present  day.  Observations 
have  satisfactorily  ascertained  the  fact,  that  persons 
of  scrofulous  habit  are  more  subject  to  consump- 
tion than  others,  and  that  the  greatest  part  of  con- 
sumptive people  evidently  have  this  disposition. 
There  are  some  physicians  too,  of  no  little  reputation, 
who,  out  of  every  hundred  patients  carried  off  by  con- 
sumption, reckon  the  proportion  of  ninety  at  least, 
to  be  scrofulous.  Besides,  there  is  certainly  a  great 
similarity  and  affinity  between  the  tubercles  and  con- 
sumptive ulcers  of  the  lungs,  and  scrofulous  tu- 
mours and  abscesses  in   other  parts  of  the  body. 


102 

They  also  have  the  same  external,  and,  if  they  be 
cut  by  the  knife,  the  same  internal  appearance;  the 
same  thickness  and  hardness.  In  the  same  way  they 
often  increase  by  degrees  from  a  small*  beginning 
to  a  large  tumour,  and  generally  without  much  pain 
or  inconvenience;  they  suppurate  tardily  and  with 
difficulty,  and  never  pass  into  a  healthy  suppura- 
tion, but  are  resolved  into  offensive  and  almost  in- 
curable ulcers.  Both  appear  at  the  same  seasons  of 
the  year,  that  is,  in  winter  and  the  spring;  upon  the 
approach  of  summer  they  are  mitigated  or  discussed; 
and  on  the  return  of  spring  both  often  reappear.  And 
lastly,  in  dissecting  the  dead  bodies  of  those  who  evi- 
dently died  of  scrofula,  scrofulous  tumours  in  all 
parts  of  the  bodies,  and  tubercles  in  the  lungs  of 
the  same  kind,  have  not  unfrequcntly  been  found; 
this  it  has  happened  to  me  to  see  twice  or  thrice. 
From  all  these  things  il  is  sufficiently  evident, 
that  consumption  of  the  lungs  often  arises  from  a 
scrofulous  disposition,  and  that  it  is  a  true  scrofulous 
disease.  Wherefore,  when  consumption  occurs  in 
those,  who  are  either  manifestly  scrofulous  them- 
selves, or  born  of  scrofulous  parents,  it  is  generally 
to  be  attributed  to  this  cause. 


103 

Perhaps  some  may  believe  that  it  would  not  avail 
much  in  this  complaint,  that  its  cause  should  be  es- 
tablished by  the  most  unequivocal  symptoms.  For 
scarcely  any  disease  is  more  obscure  or  more  diffi- 
cultly cured  than  scrofula,  even  when  it  affects  exter- 
nal parts,  to  which  remedies  adapted  to  the  disorder, 
can  be  directly  applied.  Indeed  I  honestly  confess  that 
almost  all  remedies  are  for  the  most  part  exhibited 
in  vain,  and  from  their  effects  I  have  never  been  able 
to  collect  any  thing  that  argued  a  probable  advantage 
from  a  change  of  climate.  Neither  can  much  be  ga- 
thered from  the  causes,  for  nothing  is  more  obscure 
than  they. 

There  are  various  opinions  with  regard  to  the 
proximate  cause  of  scrofula:  some  attribute  the  dis- 
ease to  a  lentor  and  other  vitiated  properties  of  the 
lymph;  others  think  the  vice  is  not  in  the  lymph,  but 
'  depending  on  the  lymphatick  vessels  themselves,  and 
which  they  believe  arises  from  various  causes,  as  debi- 
lity, laxity,  and  preternatural  enlargement.  Others 
think  the  disease  arises  from  some  morbid  matter, 
either  engendered  in  the  system,  or  received  from  pa- 
rents, which  by  some  .inexplicable  process  is  secreted 
from  healthy  fluids,  and  deposited  in  particular  parts 


104 

of  the  body,  especially  the  lymphatick  glands.  There 
is  no  necessity  to  expatiate  in  this  place  upon  these 
diverse  notions;  for  whether  they  be  correct  or  incor- 
rect, unless  they  be  more  accurately  investigated,  no 
curative  indication  arises  out  of  them,  which  calls  for  a 
change  of  climate.  The  remote  causes  of  this  disease 
are  not  any  better  understood;  for  it  is  not  agreed 
among  physicians  whether  a  slender  diet,  consisting 
principally  of  fruits  and  the  like,  similar  to  that  of  the 
poor,  and  especially  of  the  country  people,  should  be 
freely  used;   or  wliether  a  more  generous  diet  and 
abounding  in  the  luxuries  of  the  rich,  is  best  suited 
to  this  disease.  I  will  not  venture  to  assert  that  scro- 
fula arises  from  the  effects  of  any  particular  climate: 
for  it  is  scattered  throughout  the  terraqueous  globe. 
It  is  known  in  all  regions,  whether  cold,  or  warm,  or 
temperate;  and  every  age  has  witnessed  it.  Universal 
as  this  plague  is,  yet,  if  I  be  not  deceived,  it  is  most 
common  in  cold  moist  countries;  and  of  rare  occur- 
rence in  temperate  and  dry  ones.  From  the  observa- 
tions of  some  of  our  physicians  who  have  travelled  in 
Italy,  this  disease  is  more  rare  there  than  in  our 
island.  It  is  also  more  rare  in  Spain.  A  very  intelli- 
gent man,  who  practised  medicine  many  years  in 
Cadiz,  replied  to  my  enquiries  on  this  subject,  that 


105 

he  had  seen  very  few  persons  there  labouring  under 
this  complaint,  ^nd  none  affected  with  rickets,  a  dis- 
ease which  many  physicians  imagine  to  be  nearly  al- 
lied to  scrofula.  But  I  have  known  other  physicians  to 
affirm  that  scrofula  was  quite  frequent  in  Spain.  From 
these  things,  therefore,  scarcely  any  thing  can  be  ga- 
thered until  the  fact  is  more  accurately  investigated. 
There  are  some  who  strenuously  declare  that  this 
complaint  is  more  frequent  in  Ireland  than  in  Great 
Britain;  and  in  the  western  parts  of  this  island  than 
in  the  eastern;  a  circumstance  that  can  be  attributed 
to  no  other  cause  than  the  greater  humidity  of  those 
parts.  And  indeed  in  this  island,  so  far  as  I  am  able 
to  ascertain,  it  is  more  frequent  in  moist  places  than 
in  dry.  It  is  therefore  probable  enough  that  a  scrofu- 
lous patient  would  receive  some  relief  from  travelling 
into  dry  and  moderately  warm  countries.  This  will 
perhaps  appear  a  very  uncertain  expectation;  but  if  I 
am  not  much  deceived,  it  is  greaUy  strengthened 
by  the  history  of  the  disease,  and  by  analogy  of  those 
things  that  have  an  useful  or  pernicious  influence. 

Although  scrofula  rarely  falls  upon  the  lungs  be- 
fore the  patient  has  reached  the  fifteenth  year  of  his 
age,  yet  generally  it  is  found  much  earlier  in  other 

O 


106 

parts  of  the  body,  especially  in  the  glands  of  the 
neck.  Sometimes  indeed,  and  not  rarely,  no  symp- 
tom of  scrofula  is  observable,  until  tubercles  arc 
formed  in  the  lungs,  and  consumption  has  com- 
menced, which  doubtless  had  arisen  from  this  source 
if  the  patient  should  have  had  an  hereditary  taint,  that 
is  to  say,  born  of  scrofulous  parents.  When  scrofula 
shows  itself  in  external  parts  of  the  body,  it  is  for  the 
most  part  between  the  fifth  and  twelfth  year,  and  some- 
times, though  rarely,  it  aiRicts  the  unfortunate  vic- 
tim even  from  its  infancy.  Sometimes  also,  but  very 
rarely,  it  appears  in  more  advanced  age.  When  the  dis- 
ease occurs  but  once,  mostly  about  the  age  of  puberty, 
it  is  cured  by  the  efforts  of  nature,  and  spontaneously 
disappears;  and  never  after  does  it  trouble  the  pa- 
tient,  unless  unfortunately  it  falls  upon  the  lungs, 
and  produces  consumption.  How  this  relief  is  effected, 
I  confess  I  do  not  know.  Great  changes  are  pro- 
duced in  the  human  constitution  at  that  period, 
which  are  not  accurately  understood:  but  by  these 
changes  alone,  many  diseases  are  entirely  cured. 
This  is  a  remedy  therefore  that  we  can  with  difficulty 
comprehend,  and  never  be  able  to  imitate.  But  another 
most  efficacious  remedy  in  this  disease,  and  not  an 
artificial  one  but  produced  by  nature,  it  is  acknow- 


107 

ledged  we'can  imitate  by  a  change  of  climate.  It  is  uni- 
versally known,  that  external  scrofulous  tumours  are 
not  always  stationary,  but  at  one  time  are  augmented, 
at  another  diminished;  sometimes  vanish,  and  after- 
wards reappear.  These  changes  are  observed  to  be 
produced  by  the  different  seasons  of  the  year.  Scro- 
fulous swellings  begin,  for  the  most  part,  about  the 
winter  solstice;  in  the  spring  they  are  increased;  but 
upon  the  approach  of  summer  their  augmentation 
ceases;  during  the  summer  and  autumn  they  disap- 
pear, or  at  least  become  very  much  diminished; 
and  on  the  return  of  winter  they  are  reproduced. 
Frequently  too,  when  these  tumours  suppurate  and 
produce  foul  ulcers,  they  will  not  yield  to  any  reme- 
dies, but,  on  the  approach  of  summer,  they  sponta- 
neously heal.  Now  tubercles  in  the  lungs,  as  far  as 
we  are  able  to  learn  from  various  symptoms,  are  ob- 
served to  be  affected  in  the  same  way  by  the  different 
seasons  of  the  year.  For  the  patients  in  the  winter  or 
spring  are  often  affected  with  a  slight,  frequent,  trou- 
blesome, and  dry  cough,  and  difficult  respiration. 
From  these  symptoms,  especially  in  those  of  scrofu- 
lous disposition,  consumption  is  always  to  be  feared. 
Yet  not  unfrequently  they  spontaneously  recede  dur- 
ing the  summer  season,  but  return  in  autumn  or  in 


108 

winter;  and  upon  the  advance  of  spring,  death  carries 
off  the  patient. 

Is  it  not  therefore  highly  probable,  that  the  winter 
season  is  extremely  injurious  to  all  ulcers  and  scrofu- 
lous tumours  wherever  they  may  be  seated?  It  is  not 
altogether  unlikely  either,  that  the  severity  of  a  cold 
climate  supplies  certain  remote  causes,  both  ex- 
citing and  predisposing,  of  the  disease.  And  if  we  ad- 
mit this,  by  analogy  it  must  be  granted:  that  sum- 
mer, or  a  moderately  warm  climate  will  remove,  or 
guard  against  those  remote  causes,  so  that  every 
obstacle  to  the  resolution  of  the  tumours  and  the 
healing  of  the  ulcers  being  removed,  the  healing 
powers  of  nature  would  overcome  the  disorder.  The 
disease  lurking  in  the  constitution  generally  falls  upon 
the  weak  parts.  Now,  moderately  warm  air  is  favoura- 
ble to  respiration,  and  invigorates  the  lungs:  why  then 
should  we  not  think  that  a  moderately  warm  climate 
would  in  this  manner  overcome  consumption,  or  in 
some  other  hidden  way  would  ward  off  the  proxi- 
mate causes  of  the  disease?  But  in  whatever  manner 
the  injury  has  arisen;  whether  winter  gives  rise  to  the 
remote  causes  of  the  complaint,  or  only  exerts  an 
injurious  effect  upon  the  disease  already  existing:  it 


109 

is  clearly  evident,  that  the  danger  can  be  avoided  in  no 
other  way  than  in  flying  from  the  intemperance  of  the 
winter  season,  by  travelling  into  warmer  countries. 
If  the  patient  should  undertake  a  journey  into  suita- 
ble countries,  where  he  could  sojourn  for  a  sufficiently 
long  time:  he  might  enjoy  a  perpetual  summer 
throughout  the  whole  year,  or  if  necessary,  for  many 
years  together.  Thus  might  all  the  inconveniences 
of  our  long  winter  be  avoided;  and  whatever  good  is 
received  from  our  summer,  might  be  thus  derived  at 
pleasure  from  the  summer  season  of  foreign  countries; 
and  we  might  expect,  not  only  that  a  stock  of  health 
would  be  procured,  but  also  that  it  would  be  greatly 
augmented.  And  indeed  to  me  it  does  not  by  any 
means  appear  absurd  to  expect,  that  if  a  summer 
lasting  for  four  months  exerts  so  powerful  an  influ- 
ence as  to  heal  scrofulous  ulcers,  dissipate  tumours, 
and  in  fine,  drive  away  the  disease  for  many  months; 
a  perpetual  summer  would  not  only  hinder  the 
return  of  the  complaint  for  a  long  time,  but  also 
change  the  whole  habit  of  body,  and  radically  extir- 
pate the  scrofulous  disposition,  so  that  all  danger 
of  scrofulous  consumption  afterwards  supervening, 
would  be  entirely  prevented.  It  cannot  be  objected  to 
these  arguments,  that  scrofula  is  sometimes  found 


110 

in  warm  countries:  for  it  is  well  known  that  climate 
exerts  much  more  powerful  eifects  upon  foreigners 
than  upon  natives.  When  the  constitution  is  accus- 
tomed  to  much  heat,  certainly  it  does  not  derive 
much  advantage  or  inconvenience  from  it.  If  there- 
fore heat  is  a  remedy  for  the  disease,  the  more  one  is 
accustomed  to  it,  the  higher  is  the  degree  of  it 
that  may  be  employed;  and  perhaps  nothing  else  is 
requisite  to  cure  the  scrofula  of  Spain,  than  a  journey 
into  a  still  warmer  climate. 

All  these  circumstances  are  greatl}  confirmed  by 
observation  of  the  effects  which  experience  shows  to 
result  from  a  change  of  climate,  in  curing  or  pre- 
venting incipient  consumption.  Many  of  our  inhabi- 
tants every  year,  who  have  every  symptom  of  inci- 
pient tubercles  in  the  lungs,  seek  milder  climates  upon 
the  approach  of  cold  weather,  where  they  remain  one 
or  two  winters.  Some  are  relieved  altogether  from 
the  disease,  and  return  to  their  native  country  healthy 
and  robust,  and  never  afterwards  perceive  any  sign  of 
consumption.  Whilst  others,  who  have  tarried  abroad 
only  one  winter,  return  home  believing  themselves 
cured:  but  in  the  first  winter  they  are  seized  with 
their  former  complaint,  and  die  in  a  short  time.  If 


Ill 

then  a  change  of  climate  exerts  such  a  mighty  in- 
fluence  in  curing  this  disease,  that  it  can  remove  or 
dissipate  tubercles  already  formed:  how  much  more 
powerfully  ought  it  hot  to  operate,  in  preventing 
them.  And  so  the  fact  is:  for  though  scrofula  some- 
times occurs  in  the  warmer  climates,'^  yet  consump- 
tion of  the  lungs  is  rarely  observed.  It  is  reasonable 
therefore  to  expect,  that  our  scrofulous  patients  who 
have  gone  abroad  into  such  countries  before  the 
phthisical  age,  will  be  free  from  consumption.  From 
all  these  facts  it  appears  very  evident  to  me,  that  a 
change  of  climate  promises  the  most  advantageous 
effects  in  curing  and  preventing  phthisis  pulmonalis, 
arising  from  scrofula;  but  certainly  it  is  much  better 
to  guard  against  a  disease  so  dangerous,  than  to  con- 
tend with  it  when  already  formed. — The  learned 
Mead  long  ago  advanced  a  similar  opinion,  in  his  most 
excellent  medical  maxims  and  precepts,  respecting 
the  use  of  a  change  of  climate  in  guarding  against 

*^  This  disease  is  very  common  in  Mexico.  Indeed  it  appears 
to  be  a  more  common  complaint  than  is  generally  imagined. 
Professor  Barton  says,  in  his  lectures  on  the  Practice  of  Phy- 
sick,  that  it  is  an  extremely  common  disease  among  our 
North  American  Indians.  This  fact,  which  the  professor  has 


112 

consumption  in  persons  of  scrofulous  habit.  I  shall 
here  quote  his  words:  **  A  change  of  climate  often 

substantiated  by  the  most  satisfactory  proof,  seems,  if  we  ad- 
mit the  identity  of  scrofula  and  consumption,  in  direct 
opposition  to  the  assertion  of  his  predecessor  in  that  chair, 
the  late  Professor  Rush,  who  says  this  last  disease  "  is  un- 
known among  the  Indians  in  North  America."*  Dr.  Bar- 
ton says,  that  it  is  a  complaint  very  rife  among  those  tribes 
the  most  remote,  and  who  have  little  or  no  intercourse 
with  the  whites,  and  that  its  fatality  among  the  Onon- 
dago  Indians  of  the  state  of  New  York,  has  nearly  extermi- 
nated that  tribe.  There  is  every  reason  in  favour  of  this  asser- 
tion; for,  that  scrofula  does  afflict  them  is  incontiovertibly 
proved,  and  where  this  disease  is  found,  phthisis  pulmonalis 
cannot  be  a  stranger.  It  will  appear  from  the  text  above,  that 
Dr.  Gregory  was  not  very  sanguine  in  his  expectations  of  the 
radical  cure  of  scrofula  by  a  change  of  climate;  and  in  those 
particular  stages  of  the  disease  in  which  he  hints  its  ineffi- 
cacy,  there  will  be  found  but  little  indeed,  to  cause  a  difference 
in  opinion  from  this  learned  author.  The  basis  of  the  hope  of 
curing  scrofula  by  a  change  of  climate,  rests  undoubtedly  on 
the  fact,  that  an  atmosphere  surcharged  with  moisture,  is 
highly  favourable  to  the  production  or  evolution  of  scrofulous 
symptoms,  when  they  have  not  yet  appeared,  and  to  the  evi- 
dent aggravation  of  them,  when  the  disease  is  already  formed. 
The  change  from  a  climate  possessing  such  unpropitious 

*•  Thoughts  on  the  Cmuse  and  Cure  of  Pulmonary  Consumption. 


113 

affords  heafth,  especially  if  there  should  be  danger  of 
the  disease  (that  is  scrofula)  falling  tipon  the  Itihgs; 

qualities  fot*  the  scrofulous,  to  one  endowed  with  an  irhiforia 
dryness  and  elasticity  with  a  view  to  cure  or  alleviate  the 
disease,  is  far  from  chimerical.  In  my  practice  on  ship  boardf, 
I  have  seen  actual  benefit  from  such  a  change,  and  have 
had  one  or  two  cases  of  very  troublesome  scrofulous  ulcers  ol 
the  arms  and  legs,  which  resisted  pertinaciously  every  cflRor^ 
to  heal  them,  but  rapidly  healed  under  the  same  remedies 
after  a  change  of  climate,  and  even  under  the  disadvantageous 
effects  of  a  less  healthy  and  pure  diet,  than  that  Which  the? 
patient  had  used  in  port.  The  experience  I  have  had  withf 
this  disease  is  indeed  but  limited,  for  scrofula  is  far  from  tf 
common  complaint  among  sailors,  though  more  frequent  thstrf 
consumption:  yet  it  has  been  such  as  to  induce  me  to  believd 
that  more  relief  m^y  reasonably  be  expected  from  a  changed 
of  Climate,  even  in  the  more  advanced  stages  of  the  disease, 
than  Dr.  Gregory  is  inclined  to  think.  I  know  not  indeed, 
whether  the  sea-sickness  itself  has  any  good  effect  on  obstinate 
scrofulous  ulcers— perhaps  not — but  this  I  know,  that  in  the' 
cases  1  allude  to,  the  ulcers  exhibited  very  soon  after  going 
to  sea,  a  much  more  healthy  aspect.  I  know  further,  that 
glandular  tumours  are  undoubtedly  diminished  by  this  sick- 
ness. I  have  four  or  five  times  seen  the  detumescence  of  swel- 
lings in  the  neck  which  I  apprehended  were  strumous,  takd 
place  during  a  few  days  of  rough  weather,  and  twenty  ti'me^ 
and  more  have  I  observed  the  dissipation  of  venereal  buboes- 

p 


114 

provided  that  the  patient  chooses  a  country  not  too 
warm,  nor  too  cold,  nor  an  unhealthy  season,  for  the 

from  the  same  cause.  I  have  remarked  too  that  in  those  cases 
where  these  buboes  became  diminished,  the  subjects  of  the 
disease  were  mostly  landmen^  who  having  been  never  before  to 
sea,  were  violently  affected  by  the  motion  of  the  ship,  being 
for  days  together  vomiting,  scarcely  without  intermission. 
Dr.  Barton  mentions  in  his  lectures,  the  case  of  a  young 
gentleman  who  came  under  his  care  in  this  city,  for  a 
goitrous  swelling.  The  doctor,  after  recommending  a  va- 
riety of  remedies,  which  were  ineffectually  tried,  advised  a 
sea  voyage.  This  was  performed,  but  without  any  relief; 
another  was  undertaken  to  New  Orleans,  where  the  pa- 
tient, after  being  attacked  by  a  malignant  fever,  reeovered 
from  his  first  complaint.  The  disease  of  goitre  bears  no 
small  relation  to  scrofula,  and  a  moist  atmosphere  has 
no  little  agency  in  generating  it.  The  theory  of  Dr.  Barton 
with  respect  to  this  complaint,  and  which  the  Doctor  has  ve- 
rified by  a  few  but  strong  corroborative  facts,  refers  its  origin 
to  the  same*  causes  which  produce  intermittent  and  other 
fevers.  The  activity  of  moisture  in  marsh  exhalations,  is  well 
known.  How  reasonable  then  the  hope  that  this  singular  and, 
in  the  female  sex  particularly,  this  very  unseemly  complaint, 
would  derive  much  benefit  from  a  change  of  climate  to  one  of 
a  dry  atmosphere!  But  to  return  to  scrofula.  I  have  said  the 
foundation  of  the  hope  of  relieving  scrofulous  patients  by  a 

*  Vide  Memoir  concerning  the  Disease  of  Goitre,  &c.  Philad.  1800.  p.  57. 


115 

change."  Under  the  protection  of  such  a  name,  I 
repeat    my    opinion    with  confidence;    nor   am    I 

change  of  climate^  is  built  on  the  acknowledged  pernicious 
agency  of  moisture  on  the  disease.  In  corroboration  of  this,  I 
will  quote  a  passage  from  Dr.  Russel's*  valuable  work  on 
this  complaint.  ^<  The  disadvantages  of  a  bad  climate,  and  of 
an  unfavourable  local  situation,  can  only  be  radically  sur- 
mounted by  changing  the  place  of  residence  to  one  more  sa- 
lubrious; or,  if  such  a  change  is  not  practicable,  by  adopting 
the  best  artificial  substitute  to  correct  the  inconvenience.  As 
cold  and  moist  air  is  found  to  be  so  highly  prejudicial  in  scro- 
fula, we  endeavour  to  substitute  an   artificial   atmosphere, 
which  may  be  warm  and  dry,  and  which  therefore  may,  as  far 
as  possible,  counteract  the  pernicious  tendency  of  an  inhos- 
pitable climate.  Artificial  fires  are  equal  to  support  a  mode- 
rate and  proper  temperature  within  doors,  and  persons  of  de- 
licate constitutions,  who  are  threatened  with  an  attack  of  scrp- 
fula,  ought  to  be  permitted  to  go  abroad  in  winter  only  for  a 
short  time  at  once,  so  that  they  may  not  be  chilled,  nor  suffer 
any  injury  from  long  continued  exposure  to  cold  and  damp 
air."  In  another  placet  l^r.  Russel  attributes  so  much  good 
effect  to  the  influence  of  regular  and  continued  exercise  in 
preventing  scrofula,  that  it  would  seem  as  if  the  doctor  had 
kept  in  his  mind  the  exercise  produced  by  the  motion  of  a 


♦  Treatise  on  Scrofula.  Edinburgh,  1808.  p.  59. 
t  Ibid.  p.  52. 


11.6 

ashamed  that  my  conclusions  should  be  rendered 
sound  in  this  manner.  With  regard  to  the  benefit 
that  may  be  expected  in  scrofulous  consumption, 
from  the  exercise  itself  of  the  journey,  I  shall  not  pre- 
sume to  advance  any  thing  from  experience.  But 
cases  related  by  Sydenham  show,  that  exercise  pro- 
duces the  happiest  effects  on  this  complaint.  Relief 
and  assistance  therefore,  might  be  expected  from 
the  exercise  of  the  journey  itself,  in  this,  as  in  many- 
other  diseases. 

Another,  and  not  unfrequent  cause,  of  consump- 
tion, in  this  island  at  least,  is  hasmoptysis.  How  it  pro- 
duces  consumption,  I  shall  not  undertake  thoroughly 
to  explain;  since  however,  experience  has  taught 
that  phthisis  pulmonalis  generally  succeeds  haemop. 
tysis,  I  have  no  doubt  but  that  this  might  be  as- 

vessel  at  sea,  when  he  wrote  as  follows:  <<  The  exercise  of  per- 
sons studious  to  ward  off  an  attack  of  scrofula,  ought  to  be  re- 
gular, moderate,  and  long  continued,  sufficient  to  dispose 
them  to  rest,  but  not  of  incurring  that  degree  of  fatigue  whiph 
would  excite  a  temporary  fever,  or  permanently  impair  the 
strength.  It  seems  immaterial  what  kind  of  bodily  exercise  is 
preferred,  provided  the  above-mentioned  circumstances  be 
properly  attended  to  by  the  patient." 


U7 

signed  as  the  cause  of  consumption.  Certain  physi- 
cians, as  we  have  mentioned  above,  think  that  a  mere 
rupture  of  the  blood-vessels,  such  as  occurs  at  least 
generally  in  haemoptysis,  produces  an  incurable 
ulcer  and  consumption;  for  by  the  violent  circulation 
of  the  blood  in  the  lungs,  and  their  continual  motion 
in  respiration,  and  the  free  access  of  air,  the  wound 
is  kept  open,  and  its  healing  perpetually  obstructed. 
It  is  not  necessary  to  repeat  the  arguments  by  which 
this  opinion  is  refuted.  Experience  satisfactorily 
proves,  that  consumption  does  not  happen  at  least  in 
piost  cases,  from  a  mere  rupture  of  a  blood-vessel 
in  the  lungs,  nor  indeed  from  suppuration  itself,  pro- 
vided that  viscus  had  been  previously  sound.  Others 
assign  another  and  indeed  much  more  probable  cause 
of  the  disease:  namely,  that  the  blood  effused 
into  the  lungs  from  ruptured  vessels  is  not  intirely 
^ejected  by  coughing,  but  some  portion  of  it  remain- 
ing in  the  lungs,  is  there  putrefied,  and  irritates  and 
corrodes  the  neighbouring  parts,  and  at  length  pro- 
duces a  foul  and  incurable  ulcer.  I  do  not  doubt,  but 
a  great  deal  of  injury  might  arise  from  this  source: 
yet  if  I  am  not  mistaken,  that  injury  rarely  happens, 
unless  the  lungs  have  been  previously  affected  with 
some  taint.  Fpr  in  other  parts  of  the  body,  provided 


118 


the    constitution    be   sound  and   vigorous,    blood 
effused  in  the  cellular  texture,  is  soon  absorbed  with- 
out any  injury  or  danger.  I  have  seen  the  arm,  after 
blood-letting  unskilfully  performed,  covered  with  a 
livid  hue  from  the  wrist  up  to  the  shoulder:  yet 
neither  suppuration  nor  gangrene  arose  from  it;  the 
the  blood  spontaneously  disappeared,  so  that  after 
twenty  days  no  trace  of  the  affection  was  left.  Often 
also,  there  are  no  ulcers  formed  in  the  lungs  after 
haemoptysis,    although   it   is  hardly  probable   that 
all  the  blood  effused  ,in  them  is  expectorated  by 
coughing.  If  therefore  no  such  injury  is  produced 
after  haemoptysis,  it  is  probable   that   the  effused 
blood  not   rejected    by   spitting,    has   been    taken 
up  by  the  absorbent  vessels.  But   if,  from  some 
cause  or  other  this  is  not  effected,  we  may  readily 
believe,  that  an  ulcer  and  other  bad  consequences 
might  arise  from  the  putrefaction  of  blood  effused 
into  the  cellular  substance  of  the  lungs.  Besides, 
such  a  load  in  the  lungs  would  without  doubt  excite 
frequent  coughing,  than  which  nothing  contributes 
more  to  produce  consumption,  as  will  afterwards 
be  proved. 

Lastly,  there  are  some  who  inculcate  the  notion 


119 

that  haemoptysis  is  not  the  cause  of  consumption, 
but  only  a  sign  and  effect  of  its  cause.^°  They  be- 
lieve that  phthisis  arises  from  tubercles  in  the  lungs 
which  had  for  a  long  time  existed  before  haemop- 
tysis begun,  and  which  they  affirm,  brought  on  that 
disease,  or  rather  symptom;  in  other  words,  the  blood- 
vessels being  so  compressed  by  their  own  mass,  that 
the  blood  is  disembogued  either  by  transudation  or 
from  ruptured  vessels,  into  the  lungs.  Dissections 
also  of  dead  bodies  plainly  show,  that  tubercles, 
whether  scrofulous  or  produced  by  other  causes,  are  a 
frequent  cause  of  consumption,  or  at  least  accompany 
it;  and  it  appears  from  observations  that  tubercles 

20  An  ingenious  French  writer,  whom  I  have  before  quoted, 
and  who  has  taken  particular  pains  to  refute  the  reasoning  and 
arguments  advanced  by  Dr.  Thomas  Reid  and  others,  in  fa- 
vour of  the  use  of  sea-voyages  in  pulmonary  consumption, 
after  strenuously  opposing  the  mode  of  cure  recommended  by 
Dr.  Reid,  by  means  of  emeticks,  and  asserting  that  it  is  pre- 
dicated on  a  false  theory  of  the  disease,  asks  with  a  tone  of 
great  self-conviction:  **  quel  est  le  medecin  a  gut  il  soit  encore 
fiermis  dHgnorer  que  cea  fihlegmes^  que  cea  mucoaites,  que  ces 
oollea  aont  l^ effect  et  non  la  cauae  de  la  phthisic? — Traite  sur  la 
Nature  et  le  Traitement  de  la  Phthisic  Pulmonaire,  par  Julien 
BounafoK  Demalet,  p.  170. 


120 

arise  in  the  lungs  from  other  causes  besides  a  Scro- 
fulous disposition.  Certain  mechauicks  are  very 
much  exposed  to  dust  from  the  nature  of  thtrf 
trades;  as  for  example,  those  engaged  in  grinding 
flour,  cutting  stones,  hackling  flax,  and  other  similar 
occupations,  arc  very  liable  to  tubercles  in  the  lungs 
and  to  pulmonary  consumption;  nor  can  this  be  im- 
puted to  any  other  cause  than  the  dust  which  they 
daily  receive  into  the  lungs.  Yet  I  can  by  no  means 
believe,  that  consumption  does  not  arise  from  hae- 
moptysis, unless  tubercles  have  previously  existed 
in  the  lungs:  for  in  the  dissections  of  the  bodies 
of  those  who  died  of  this  disease,  a  large  ulcer  is 
often  found,  but  no  tubercles;  many  phthisical  pa- 
tients also,  after  an  attack  of  haemoptysis,  are 
carried  off*,  who  before  this  seized  them,  had  never 
exhibited  any  signs  of  tubercles.  Sometimes  also, 
after  a  badly  treated  peripneumony  whic  h  has  ter- 
minated in  suppuration,  a  genuine  consumption  of 
the  lungs  follows,  although  there  had  before  been  n6 
signs  of  tubercles.  And  sometimes,  though  rarely, 
consumption  is  produced  by  great  external  force  in- 
flicted on  the  lungs. 

In  the  proximate  and  remote  causes  of  hsemop- 


121 

tysis  then,  and  in  the  state  not  only  of  the  lungs,  but 
of  the  whole  system,  which  precedes  and  accompa- 
nies it — is  to  be  sought  the  reason  why  phthisis  pul- 
monahs  succeeds  this  complaint. 

From  the  observations  of  physicians  it  satisfacto- 
rily appears,  that  a  disposition  to  haemoptysis  is  often 
received  from  parents;  hence  it  is  evident,  that  the 
disease  does  not  derive  its  origin  from  any  slight  or 
accidental  cause,  but  from  the  formation  and  peculiar 
constitution,  as  well  of  the  lungs,  as  of  the  whole 
body.  For  it  is  well  known  that  parents  often  transmit 
their  temperament  and  peculiar  conformation,  to  their 
offspring:  and,  at  least  in  many  cases,  we  see  by  an 
evident  deformity  of  the  chest,  that  a  defective  struc- 
ture of  the  lungs  exists.  Wherever  such  a  formation 
occurs,  the  lungs  are  never  properly  distended,  and 
the  motion  of  the  blood  through  them  is  obstructed; 
hence  arise  an  irregular  circulation  and  congestion 
which  weaken  and  distend  the  blood-vessels,  and 
render  them  liable  to  rupture.  Many  of  the  exciting 
causes  which  frequently  produce  haemoptysis,  evi- 
dently induce  a  congestion  of  blood  in  the  lungs. 
For  example:  violent  exercise,  or  great  straining  of 
the  body  as  in  running,  or  in  lifting  great  weights; 

Q 


122      - 

immoderate  coughing,  vociferation,  singing,  &c.  Be- 
fore the  blood  is  discharged,  the  most  evident  symp- 
toms of  irregular  determination  and  turgescence  of 
blood  in  the  lungs,  are  almost  always  observed:  such 
as  a  sense  of  weight,  or  heat,  or  uneasiness,  or  pain 
in  the  breast,  and  a  redness  of  the  cheeks.  Upon  the 
discharge  of  blood,  all  these  spontaneously,  and 
generally  very  soon,  disappear;  and  often  by  a 
seasonable  blood-letting,  the  haemorrhage  is  alto- 
gether prevented.  It  has  been  observed  also,  that 
signs  of  spasmodick  constriction  of  the  extreme  ves- 
sels, precede  and  accompany  haemoptysis.  Some- 
times a  sudden  application  of  cold  to  external  parts, 
especially  if  the  body  has  been  previously  heated, 
produces  haemoptysis:  and  all  physicians  know  that 
nothing  conduces  more  to  prevent  and  cure  this, 
than  promoting  and  restoring  the  due  determination 
of  the  fluids  to  the  surface  of  the  body.  It  appears 
plain  therefore,  that  an  irregular  determination  and 
congestion  of  the  blood  in  the  lungs,  produces  hae- 
moptysis; wherefore  it  is  now  to  be  inquired,  how 
that  irregular  action  is  produced,  and  why  the  blood 
is  determined  to  the  lungs  in  such  an  increased 
\^  quantity. 


123 

Experience  shows  that  haemoptysis  happens  es- 
pecially to  those  who  are  accustomed  to  high  living, 
and  who  have  changed  from  a  more  active  kind  of 
life,  to  one  of  an  indolent  and  more  sedentary  na- 
ture; but  most  of  all  to  those  in  whom  some  cus- 
tomary excretions,  particularly  of  blood,  existing 
either  naturally  or  preternaturally,  have  ceased:  and 
of  this  kind,  haemorrhages  from  the  nose,  and  in 
females,  the  menses,  are  the  principal;  to  these  might 
be  added  an  omission  of  a  customary  blood-letting, 
and  sometimes,  though  rarely,  suppressed  piles.  Hae- 
moptysis also  is  observed  to  happen  oftener  in  the 
spring  of  the  year  than  at  any  other  time;  and  for  the 
most  part  to  men  only  between  the  eighteenth,  and 
thirtieth,  or  thirty-fifth  years  of  age,  in  which  period 
a  plethorick  state  is  known  to  exist  from  various 
symptoms.  It  cannot  then  be  doubted,  that  haemop- 
tysis may  arise  like  all  other  haemorrhages,  from 
plethora,  and  therefore  the  causes  of  that  plethora 
which  produces  this  complaint,  will  now  be  briefly 
related. 

During  infancy,  when  the  body  is  daily  growing, 
there  is  the  greatest  abundance  of  healthy  blood, 
which  is  required  for  nourishing  the  system,  and  sup- 


124 

porting  its  growth.  This  indeed  is  a  true  plethora,  yet 
never  of  an  unhealthy  kind.  At  that  period,  the  ves- 
sels easily  yield,  and  are  dilated,  until  the  body  has 
arrived  at  its  proper  size;  but  when  the  vessels  have 
become  stronger,  and  resist  the  blood,  then  plethora 
is  perceived,  and  haemorrhages  and  other  diseases  are 
produced  by  it. 

From  the  observations  and  experiments  of  the  ce- 
lebrated Winthringham,  junior,  it  appears:  that  a 
different  proportion  of  thickness  and  strength  of  the 
arteries  and  veins  takes  place  at  different  periods  of 
life.  In  infancy,  and  also  in  youth,  the  veins  possess 
much  more  strength  and  thickness  than  the  arteries: 
in  more  advanced  age,  the  arteries  obtain  in  their 
turn  the  greatest  strength.  The  proper  equilibrium 
is  observed  to  take  place  about  the  thirtieth  or  thirty- 
fifth  year.  Hence,  if  plethora  exists  in  the  system 
before  the  patient  has  reached  his  thirtieth  year,  it 
shows  itself  only  in  the  arteries,  or  at  least  particu- 
larly in  them;  because  the  veins,  from  their  greater 
thickness  and  strength,  are  able  to  resist  an  exces- 
sive fulness  of  blood:  but  the  arteries,  from  their 
greater  laxity  and  weakness,  receive  too  great  a 
proportion  of  blood,  and  therefore  become  distended. 


125 

Thence  arises  congestion;  and  upon  any  sudden  and 
violent  action  which  greatly  disturbs  the  distribu- 
tion of  the  blood,  a  rupture  of  the  arteries  and  con- 
sequent  haemorrhage  is  produced.  After  the  thirty- 
fifth  year,  haemorrhages  of  the  veins  generally  occur, 
but  rarely  of  the  arteries. 

When  the  increased  arteries  are  full  of  blood, 
and  yield  naturally  and  equally  to  the  strength  of 
the  veins,  and  all  parts  of  the  body  daily  increase, 
no  inconvenience  can  arise  from  that  natural  ple- 
thora.  But  when  the  growth  of  the  body  ceases, 
and  morbid  plethora  follows,  haemorrhages  ought 
first  to  appear  in  that  part  of  the  system  which  has 
first  reached  its  proper  size.  Hence  at  that  period 
haemorrhages  are  to  be  expected  in  the  head,  because 
this  part,  as  is  well  known  to  all  physicians,  painters, 
and  statuaries,  receives  its  full  growth  before  the 
other  parts.  And  this  is  the  fact:  for  haemorrhages  of 
the  nose  are  found  to  occur  before  any  others,  and 
generally  indeed,   from  the  fifth  to  the  eighth  year. 
But  when  all  parts  of  the  body  have  attained  their 
full   size,   the  reason   for  haemorrhages  happening 
most  frequently  in  the  head,  ceases  to  exist.  Then 
the  veins,  possessing  as  yet  more  strength  than  the 


126 

arteries,  haemorrhages  ought  to  happen  especially  in 
those  parts  in  which  the  blood  flows  with  the  greatest 
fulness  and  force.  Hence  appears  the  reason  why 
they  happen  at  that  period  in  the  lungs:  for  the  same 
quantity  of  blood  flows  through  the  lungs  as  circu- 
lates through  all  the  rest  of  the  body.  If  therefore, 
the  distribution  and  equable  circulation  of  the  fluids 
should  from  any  cause  be  very  much  disturbed,  it  is 
evident  that  all  the  ill  consequences  arising  thence, 
would  be  felt  particularly  in  the  lungs:  for  however 
small  that  viscus  may  be,  its  blood-vessels  always 
contain  a  great  quantity  of  blood.  A  still  larg(^r  quan- 
tity, or  even  a  greater  impetus  of  the  blood,  could  not 
be  borne  without  danger.  They  are  consequently 
easily  ruptured,  and  hence  arises  haemoptysis.  But 
afterwards,  when  the  arterial  system  has  received 
more  strength  than  the  venous  system,  that  is,  when 
man  has  passed  his  thirty-fifth  year,  hzemorrhages 
from  the  lungs,  and  indeed  from  the  arteries  in  any 
part  of  the  system,  should  not  any  more  happen.  And 
the  plethora,  if  any  exists  in  the  system,  is  felt  par- 
ticularly or  altogether  in  the  veins.  This  disorder, 
and  its  consequences,  most  frequently  happen  in 
parts  of  the  body  where  the  motion  of  the  blood  in 
the  veins  is  most  slow.  Hence  in  advanced  age  the 


127 

flowing  of  blood  occurs  oftenest  from  the  hsemor- 
rhoidal  veins;  for  the  blood  in  them  which  is  greatly 
retarded,  does  not  in  fact  return  to  the  heart,  but 
passes  through  the  vena  portarum,  and  flows  through 
the  liver.  Besides,  the  haemorrhoidal  veins  have  but 
little  assistance  from  muscular  motion,  and  want 
valves  altogether.  Hence  follow  frequent  and  great 
congestion,  and  not  seldom,  tumours  or  varices  of 
the  veins,  and  ruptures  and  effusions  of  blood. 
From  similar  causes  congestion  and  effusion  of 
blood  often  happen  in  the  brain  at  the  same  age, 
and  paralysis  and  apoplexy  (which  Hoffman  calls 
hasmorrhage  of  the  brain)  are  produced. 

From  all  these  circumstances  we  may  certainly, 
if  r  be  not  mistaken,  conclude  that  a  plethorick  state 
of  the  whole  system  and  an  excessive  determination 
and  congestion  of  blood  in  the  lungs,  is  the  cause  of 
haemoptysis.  Yet  it  is  often  observed,  that  neither 
haemoptysis  nor  other  haemorrhages,  nor  any  other 
inconveniences  arise  from  that  plethorick  state  which 
succeeds  the  cessation  of  growth  in  the  body;  nor 
from  the  excessive  thickness  of  the  veins  and  laxity 
of  the  arteries,  provided  the  constitution  shall  have 
been  sound  and  vigorous:  unless  some  powerful  ex- 


128 

citing  cause  concurs  at  the  same  time.  For  most 
men  and  other  animals  are  free  from  these  inconve- 
niences.  But  when  a  morbid  disposition  has  already- 
existed  in  the  system,  especially  weakness  of  the 
lungs,  either  derived  from  parents,  or  generated  by 
a  malformation  of  the  chest,  or  arising  from  other 
more  obscure  causes:  haemoptysis  is  frequently  pro- 
duced. And  although  no  bad  conformation  may  exist, 
particularly  in  the  lungs,  if  only  the  habit  of  the 
whole  system  be  weak,  if  a  plethorick  state  should 
supervene,  or  if  some  sudden  and  violent  external 
cause  greatly  disturbs  the  distribution  of  the  blood, 
the  bad  consequences  arising  thence,  are  felt  for  the 
most  part  in  the  lungs.  Experience  evidently  shows, 
that  from  haemoptysis  accompanied  by  such  a  deter- 
mination and  congestion  of  blood  in  the  lungs,  that 
viscus  receives  such  an  injury,  that  an  incurable 
ulcer  and  consumption  arise  from  it,  although  a 
simple  wound  would  never  be  able  to  induce  such 
bad  consequences. 

I  can  by  no  means  accurately  explain  what  changes 
are  produced  from  a  congestion  of  blood  in  the  lungs, 
and  why  an  incurable  ulcer  or  wound  should  occur 
during  the  existence  of  such  a  state  of  this  viscus.  We 


1S6 

understand  indeed  that  such  a  state  of  the  lungs  is 
far  from  being  heahhy  and  natural;  and  if  it  be  ne- 
cessary  for  curing  a  wound  or  an  ulcer,  that  the  con- 
stitution of  the  whole  body  or  any  part  of  it,  should 
be  healthy  and  strong,  it  is  no  wonder  in  this 
case,  when  the  lungs  were  already  somewhat  dis- 
eased, that  a  wound  in  them  would  be  difficult  to 
heal.  Perhaps  an  excessive  fulness  of  blood,  and 
weakness  of  the  vessels  and  of  other  solid  parts,  im- 
pede the  absorption  of  effused  blood,  or  a  healthy 
suppuration  of  an  ulcer.  Whenever  the  pathology  of 
this  viscus  shall  be  better  understood,  we  may  be 
able  to  explain  this  circumstance  more  accurately.  In 
Jthe  mean  time,  in  my  opinion,  it  is  fair  to  attribute 
consurnption  succeeding  hsemoptysis,  to  a  praeter- 
natural  determination  of  blood  to  the  lungs.  For  this 
not  only  gives  evidence  of  incipient  phthisis,  but  ac- 
companies the  disease  through  almost  its  whole  course, 
to  its  last  stages,  and  in  proportion  to  the  greater  or 
less  force  of  this  determination,  the  complaint  is  aug- 
mented or  relieved.  Thus  all  remedies  which  are 
agreed  to  be  useful  in  preventing,  mitigating  or  curing 
consumption,  manifestly  tend  to  diminish  the  abun- 
dance of  blood,  moderate  its  force,  remove  the  conges- 
tion, and  promote  an  equal  distribution.  There  is  no 

R 


130 

occasion  to  say  much  to  show  how  my  opinion 
is  confirmed;  it  naturally  arises  from  the  theory  of 
haemorrhages,  and  especially  of  haemoptysis.  Who 
does  not  know  that  hght  diet,  consisting  of  milk  and 
fruits,  and  frequent  blood-letting,  are  of  great  ser- 
vice? The  summer  season,  warm  clothing,  flannel 
shirts,  frequent  and  moderate  exercise,  riding  on 
horseback,  gestation  in  a  carriage,  and  sailing, — only 
do  good  by  diminishing  the  congestion  of  blood  in 
the  lungs,  and  promoting  a  determination  to  other, 
especially  to  external  parts. 

We  have  already  said  enough  with  regard  to 
the  effect  of  the  different  seasons  of  the  year  in 
scrofulous  consumption:  the  same  thing  happens  in 
phthisis  arising  from  haemoptysis.  There  are  some 
persons  who  in  the  spring  of  every  year,  have  all  the 
signs  of  congestion  of  blood  in  the  lungs  and  inci- 
cipient  phthisis;  an  abscess  is  formed  in  the  lungs, 
it  bursts,  and  pus  is  expectorated.  On  the  approach 
of  summer  however,  the  complaint  ceases,  and  the  pa- 
tients enjoy  the  appearance  of  health.  But  on  the  re- 
turn of  winter,  the  disease  recurs  again  and  again. 
In  this  way  life  is  sometimes  protracted  for  twenty 
years  and  more. 


131 

Although  summer  is  very  favourable  to  the  con- 
sumptive, yet  winter  is  by  no  means  the  most  dan- 
gerous season.  All  agree  that  spring  and  autumn  are 
much  the  most  injurious  to  them;  because,  in  those 
seasons  the  distribution  of  the  blood  is  most  dis- 
turbed, by  the  great  and  sudden  changes  of  the 
weather.  The  perspiration  is  copious  in  the  sum- 
mer from  the  heat  of  the  air,  and  a  due  distribution 
to  the  surface  of  the  body  is  promoted:  the  determi- 
nation however  to  the  kidnies,  and  the  quantity  of 
urine,  is  diminished.  But  in  the  winter  time,  the  ex- 
ternal cold  checks  perspiration,  and  drives  the  blood 
from  the  surface;  and  then  the  quantity  of  urine  is 
much  greater.  There  is  a  kind  of  equilibrium  there- 
fore, between  the  skin  and  the  kidnies,  so  that  when 
the  excretion  by  one  is  checked,  it  is  augmented  by 
the  other.  Hence  many  inconveniences  arising  from 
the  heat  of  summer,  and  especially  from  the  cold  of 
winter,  are  happily  avoided.  But  in  the  spring  and  in 
autumn  that  equilibrium  is  vascillating;  hence  if  an 
excessive  determination  to  the  lungs  or  any  other 
part  shall  already  have  occurred  at  those  times,  es- 
pecially by  the  action  of  the  exciting  cause,  which 
the  sudden  changes  of  the  weather  afford,  it  ought  to 
be  greatly  augmented.  When  however  a  fixed  deter- 


132 

raination  of  blood  takes  place,  either  to  the  surface  of 
the  body,  or  to  the  kidnies,  the  irregular  determina- 
tion to  the  lungs  is  lessened:  and  theri  fore  the  con- 
sumptive feel  much  less  inconvenience  from  the  dis- 
ease in  summer  and  in  winter,  when  these  determi- 
nations are  regular  and  constant.  Indeed,  instances 
have  frequently  occurred  which  plainly  show  of  how 
much  consequence  it  is,  for  preventing,  or  curing, 
or  alleviating  this  disease,  that  the  determination  of 
blood  should  be  averted  from  the  lungs.  All  physi- 
cians know  that  while  women  are  pregnant  they 
rarely  die  of  consumption  of  the  lungs.  Nay,  if  a 
woman  already  decaying  in  a  consumption  becomes 
pregnant,  the  progress  of  the  disease  is  generally  ar- 
rested, or  at  least  greatly  retarded,  until  she  brings 
forth  her  child.  Yet  often  in  a  short  time  after  par- 
turition, sometimes  in  a  few  weeks,  sometimes  in  a 
few  days  only,  they  die  of  consumption.  All  these 
facts,  if  1  am  not  deceived,  are  to  be  attributed  for 
the  most  part  to  the  diflferent  distribution  of  the 
blood.  During  gestation,  a  great  quantity  of  blood 
flows  to  the  uterus,  for  the  nourishment  and  forma- 
tion of  the  foetus.  Hence  its  determination  to  the 
lungs  is  averted;  the  congestion  in  them  is  lessened 
or  removed,  and  all  the  evils  arising  from  it,  greatly 


mitigated,  or  altogether  cured  But  in  a  short  time 
after  parturition,  that  natural  and  healthy  determina- 
tion to  the  uterus,  ceases.  It  is  not  surprising,  there- 
fore, that  the  congestion  of  blood  should  afterwards  be 
incrtastd  in  the  lungs,  and  that  the  disease  arising 
from  it,  should  grow  worse.  We  might  indeed  be- 
lieve a  priori^  that  those  unfortunate  women  had 
but  one  hope  left,  which  nature  spontaneously  ex- 
tended for  their  relief.  If  that  great  determination  to 
the  uterus  should  suddenly  cease,  and  no  other  natural 
one  was  to  succeed,  it  is  evident  that  the  disease  in 
the  lungs  would  be  greatly  augmented,  and  that  the 
greatest  danger  must  arise  thence.  But  it  is  known, 
that  in  a  short  time,  generally  a  few  hours  only  after 
parturition,  a  great  determination  naturally  takes  place 
to  the  breasts.  It  is  reasonable  enough  then  to  expect, 
that  this  new  determination  would  have  the  happiest 
effects,  provided  it  should  be  promoted  in  the  way 
nature  intended,  that  is,  by  the  woman  suckling 
her  child:  for  the  congestion  in  the  lungs  ought  to 
be  diminished  or  altogether  taken  away,  and  life  be 
protracted  until  the  disease  be  cured  by  the  powers 
of  nature.  And  in  fact,  I  have  obtained  from  the 
highest  authority  some  examples,  and  have  seen 
one  myself,  in  which  this  experiment  was   made, 


134 

and  consumption  of  the  lungs  was  most  evidently 
cured  altogether,  without  the  use  of  any  other  reme- 
dies whatever.  And  I  do  not  doubt  but  that  this  re- 
medy might  cure  many  piidiisical  persons,  especially 
if  the  disease  has  not  arrived  at  its  last  stages.  But  the 
experiment  is  rarely  tried,  for  there  are  few  who  would 
believe  that  a  woman  already  consumptive  and  nearly 
dying,  could  give  milk  to  an  infant  without  danger 
to  herself  and  the  child.  Yet  experience  teaches  that 
such  women  bear  children  and  nourish  them,  not 
only  without  injury  or  danger,  but  with  the  greatest 
benefit.  The  children  also,  at  least  in  the  generality 
of  cases,  are  never  weak  nor  sickly,  nor  are  they  ob- 
served to  experience  any  inconvenience  from  the 
disease  under  which  their  mothers  laboured.  I 
can  hardly  believe,  therefore,  if  women  suckle  their 
own  children,  that  any  danger  would  arise  from  it, 
either  to  the  child  or  parent;  and  I  am  clearly  of 
opinion  that  it  might  have  the  happiest  effects;  it  is 
better  surely  in  so  dangerous  a  disease,  to  try  an  un- 
certain remedy,  than  leave  the  patient  to  certain 
death. — But  to  return  to  the  subject. 

Although  the   determination   to  the    kidnies  is 
greater  in  winter  than  in  summer;  yet  it  is  never 


135 

constant:  for  it  is  often  disturbed  by  the  sudden 
changes  of  the  weather,  which  generally  occur  in 
winter  very  frequently.  But  if  the  winter's  cold  be 
ever  so  continued,  the  distribution  of  the  blood  would 
be  daily  disturbed,  unless  the  air  of  the  chamber  and 
the  external  air  should  be  of  the  same  temperature. 
When  the  external  air  is  excessively  cold,  the  air  of 
a  room  is  equal  to  or  greater  than  summer  heat;  hence 
arise  great  and  sudden  changes  of  the  distribution  of 
the  blood.  The  reason  then  is  clear  why  the  summer 
is  more  salubrious  to  the  consumptive  than  winter: 
for  the  determination  to  the  surface  of  the  body  which 
occurs  in  summer,  is  almost  continual;  and  although 
the  perspiration  should  be  at  one  time  more  and  ano- 
ther less,  the  determination  of  blood,  unless  from 
some  sudden  and  violent  cause  which  rarely  hap- 
pens, is  wholly  changed.  The  same  reason  may 
be  given  for  the  effects  of  seatons,  of  issues,  and 
of  blisters,  which  not  unfrequently  give  relief  to  the 
consumptive. 

There  remains  therefore,  one  method  by  which  we 
can  always  hope  to  remove  the  congestion  of  blood 
in  the  lungs;  namely,  by  promoting  a  determination 
to  the  surface  of  the  body.  Yet  this,  as  we  have  often 


1^6 

already  observed,  is  most  effectually  and  most  certain- 
ly performed,  by  a  moderate,  uniform,  and  constant 
warm  air.  But  our  climate  possesses  such  an  air  only 
for  a  few  months.  A  milder  climate  should  therefore 
be  sought  by  the  consumptive:  and  daily  experience 
confirms  sufficiently  the  propriety  of  this  advice;  for 
many  of  our  inhabitants  are  annually  snatched  from 
death,  which  under  other  circumstances  would  ine- 
vitably  happen.  Warm  clothing  and  moderate  exer- 
cise, are  somewhat  similar  to  this  remedy;  and  what- 
ever good  is  derived  from  them  is,  in  my  opinion,  to 
be  attributed  entirely  to  a  change  in  the  distri!)ution 
of  blood.  With  regard  to  clothing,  there  are  a  few 
things  to  be  observed.  It  is  well  known  that  flannel 
shirts   are  exceedingly  beneficial    in  this   disease. 
This  is  surely  a  most  simple  remedy,  and  certainly 
there  is  nothing  more  plain  than  that  it  will  directly 
promote  the  determination  of  blood  to  the  surface  of 
the  body.  Linen  shirts,  when  there  is  a  profuse  per- 
spiration,   soon   become  wet  and  feel  cold;   hence 
perspiration  is  checked.  But  flannel  shirts  easily  ab- 
sorb  sweat  or  moisture,  and  do  not  become  wet  with- 
out there  is  a  prodigious  perspiration:  hence  the  skin 
remains  dry  and  warm,  and  the  perspiration  is  greatly 
promoted.  It  is  known  to  every  one,  that  exercise 


137 

has  a  similar  effect;  it  plainly  appears  therefore,  how 
it  could  diminish  or  remove  a  congestion  in  the  lungs. 
Indeed  at  first  blush  it  would  not  be  unreaspnable  to 
apprehend  dangerous  consequences  from  exercise,  by 
reason  of  the  effect  it  has  in  increasing  the  impetus  of 
blood.  If  the  exercise  should  be  violent,  it  would  with- 
out doubt  prove  very  injurious;  for  walking,  riding, 
and  similar  more  powerful  exercises,  immediately  in- 
crease the  difficulty  of  respiration,  and  other  symp- 
toms. But  experience  has  very  clearly  proved  >  that 
moderate  exercise,  sailing,  gestation  in  a  carriage,  and 
not  unfi-equently  riding  on  horseback, — diminish  or 
remove  the  congestion  of  blood  in  the  lungs,  and  other 
injuries  arising  from  it.  This  is  evidently  to  be  attri- 
buted to  the  increased  determination  of  blood  to  the 
surface  of  the  body.  The  celebrated  CuUen,  has  men- 
tioned in  his  lectures  a  singular  case,  which  satisfac- 
torily confirms  this  theory.  It  was  that  of  a  man  who 
laboured  under  haemoptysis,  who,  while  he  remained 
at  home,  and  used  no  exercise,  was  affected  very 
badly,  and  suffered  many  returns  of  the  complaint. 
Yet  fi-om  riding  on  horseback  he  always  derived  re- 
lief; and  sometimes,  when  the  disease  greatly  troubled 
him,  he  mounted  his  horse  and  rode  for  some  time, 
with  the  effect  of  being  freed  from  the  complaint,  for 

S 


138 

a  time  at  least.  Gilchrist  relates  other  examples  of  a 
like  nature,  from  the  effect  of  sailing. 

But  Sydenham  extols  this  remedy  more  than  all  other 
physicians;  and  not  only  in  the  slight  and  incipient 
form  of  phthisis,  but  even  in  the  last  stages  of  the 
complaint,  when  that  species  of  diarrhoea  with  night 
sweats  termed  colliquative,  has  already  come  on,  and 
which  is  generally  soon  followed  by  death:  "  However 
fatal  consumption  may  be,  (says  this  writer,)  yet  I 
firmly  maintain,  that  neither  mercury  in  the  venereal 
dist^ase,  nor  Peruvian  bark  in  intermittent  fever,  arc 
more  efficacious,  than   the  exercise  already   com* 
mended,  (that  is,  riding  on  horseback,)  is  in  curing 
consumption;  provided  the  patient  takes  care  to  have 
his  sheets  or  bed  clothes  properly  dried,  and  also, 
that  he  protracts  his  ride  to  a  long  journey.  This  I 
have  learned  from  numerous  experiments  in  which  it 
scarcely  ever  failed.  And  although  riding  on  horse- 
back   is   peculiarly  suitable  for   consumption,  yet 
journies  performed  in  a  carriage,  when  they  have  been 
judiciously  taken,  have  had  the  happiest  effects."" 

31  Bishop  Burnet  says,  that  the  lawyers  of  his  time  were 
(caeteris  paribus)  longer-lived  than  other  people;  and  attributes 


139 

Later  physicians  do  not  bestow  such  praises  upon 
this  exercise;  yet  ail  agree  that  it  is  often  of  the 
greatest  use.  It  is  evident  therefore,  how  much  ben^:fit 
consumptive  patients,  labouring  under  hered'tiry 
hsemoptysis,  might  derive  from  the  exercise  itself  of 
travelling. 

The  third,  and  indeed  the  most  frequent  cause  of 
consumption,  yet  remains  to  be  noticed:  namely,  ca- 
tarrh. Every  one  knows  that  consumption  of  the  lungs 
not  unfrequently  succeeds  a  protracted  catarrh:  but  it 
is  often  difficult  to  distinguish  catarrh  from  genuine 
incipient  consumption  produced  by  tubercles  in  the 
lungs:  for  the  principal  symptom,  that  is  the  cough, 
occurs  in  both;  and  I  do  not  doubt  but  that  many 
consumptions  attributed  to  catarrh  derive  their  ori- 
gin from  tubercles.  But  it  is  clear  enough  that  catarrh 
not  unfrequently  induces  true  consumption,  when  no 
tubercles  had  previously  existed  in  the  lungs.  For 
there  are  many  instances  where,  after  the  most  evident 

this  to  their  riding  the  circuits  on  horseback:  but  this  is  un- 
doubtedly too  violent  an  exprtion,  except  in  the  first  stages  of 
phthisis.  There  are  few  physicians  of  the  present  day,  I  be- 
lieve, who  would  recommend  their  patients  to  try  this  jolting 
remedy,  in  any  other  period  of  the  complaint. 


140 

symptoms  of  catarrh  arising  from  common  causes, 
(that  is,  cold  some  how  applied  to  the  body,)  a  ge- 
nuine and  fatal  consumption  of  the  lungs  followed; 
although  there  were  no  previous  signs  of  tubercles, 
or  any  disease  in  the  lungs,  and  where  there  was  no 
suspicion  that  a  scrofulous  disposition  existed  in  the 
system.  Sometimes  also,  and  not  seldom,  consump- 
tion of  the  lungs  arises  from  whooping  cough. 

Since  therefore,  there  is  not  the  least  doubt  of  the 
fact,  that  long  continued  catarrh  produces  consump- 
tion, the  rationale  may  now  be  given;  and  if  I  mis- 
take not,  the  same  which  we  have  above  advanced 
respecting  haemoptysis,  may  be  easily  applied  to 
consumption  arising  from  catarrh.  If  congestion  of 
blood  in  the  lungs  renders  them  liable  to  consump- 
tion, we  may  easily  understand  how  a  frequent  and 
violent  cough  might  excite  that  injury:  for  it  is  evi- 
dent that  a  cough  of  this  kind  impedes  the  motion  of 
the  blood  and  produces  a  great  turgescence.  Perhaps 
the  mucous  nriembrane  (which  is  particularly  affected 
in  catarrh)  may  receive  some  injury  from  the  disease, 
which  might  induce  the  mischievous  consequences. 
But  what  that  affection  is,  (if  any  in  fact  there  be,) 
I  shall  not  undertake  to  explain.  If  the  lungs  therefore 


141 

are  weak  or  diseased,  if  a  defective  and  contracted 
structure  of  the  chest  exists,  or  if  any  taint  lurks  in  the 
constitution:  it  is  no  wonder  that  a  protracted  catarrh 
should  produce  consumption  at  that  age,  in  which 
the  greatest  determination  of  blood  to  the  lungs 
occurs. 

When  consumption  is  produced  by  catarrh,  all 
the  symptoms  of  turgescence  of  blood  in  the  lungs 
come  on,  and  sometimes  haemoptysis  takes  place. 
The  history  and  progress  of  the  disease  is  nearly  the 
*  same,  whether  it  arises  from  haemoptysis  or  catarrh; 
the  same  things  afford  relief  and  do  injury,  and  the 
mode  of  cure  is  the  same.  There  is  not,  therefore, 
the  least  necessity  to  repeat  in  this  place  what  has 
already  been  said.  If  congestion  in  the  lungs  be  the 
source  and  cause  of  this  complaint,  that  should  with- 
out  doubt  be  removed  in  the  first  place.  And  this 
effect  is  best  achieved  by  means  of  the  remedies  be- 
fore enumerated,  and  especially  by  a  change  of 
climate. 

Of  these  three  most  frequent  causes  of  consump- 
tion, (or  rather  two;  for  haemoptysis  and  catarrh 
might  be  considered  as  one,)  we  have  treated  sepa« 


142 

ratdy,  as  if  the  disease  might  arise  from  one  or  the 
other  only-  But  it  is  evident  enough  that  all  those 
causes  may  concur  or  be  conjoined  in  the  same  pa- 
tient.  Catarrh  often  induces  haemoptysis:   perhaps 
also  it  weakens  the  lungs,  and  renders  them  liable  to 
scrofulous  tubercles.  Blood  effused  from  haemoptysis, 
and  not  absorbed,  might  form  tubercles,  which  in  pro- 
gress of  time,  might  induce  inflammation  and  suppu- 
ration. And  from  compression  of  the  blood-vessels  by 
scrofulous  tubercles,  effusion  of  blood,  either  by  tran- 
sudation or  from  ruptured  vessels  might  be  produced, 
be  followed  by  haemoptysis,  and  cause  a  frequent  and 
troublesome  cough.  What  has  been  particularly  and 
separately  said  of  these  two  causes,  *  may  easily  be 
applied  to  all  conjoined.  From  all  these  facts  and 
arguments,  it  may  be  concluded,  if  I  be  not  mis- 
taken,  that  a  change  of  climate  would  be  of  the 
greatest  importance  in  preventing  and  curing  con- 
sumption of  the  lungs.^^ 

22  It  seems  then  agreed,  that  a  change  of  climate  exerts 
powerful  and  beneficial  effects  upon  phthisis  pulmonalis,  whe- 
ther it  arises  from  hereditary  predisposition,  concealed  scro- 
fula, haemoptysis  or  catarrh,  and  the  suppurative  terminations 
of  pneumonia.  But  it  seems  not  to  be  so  unanimously  con- 
ceded, that  this  change  of  climate  is  always  to  be  made  by 


143 

It  is  now  our  intention  to  treat  of  certain  diseases 
which  occur  in  more  advanced  age,  and  which  arise, 

means  of  a  sea  voyage,  in  preference  to  a  journey  by  land.  The 
opinions  on  the  usefulness,  nay  curative  effects  of  sailing  in 
this  disastrous  complaint,  are  various  and  diametrically  oppo- 
site. The  late  professor  Rush  was  wont  to  teach  the  inefficacy 
of  this  species  of  exercise,  unconnected  with  other  things,  in 
consumption,  from  his  chair;  and  the  following  are  his  senti- 
ments as  delivered  in  one  of  his  publications:  "  sea  voyages 
have  cured  consumption,  but  it  has  only  been  when  they  have 
been  so  long,  or  so  frequent,  as  to  substitute  the  long  con- 
tinued gentle  to  the  violent  degrees  of  exercise,  of  a  shorter 
duration,  or  where  they  have  been  accompanied  by  some  de- 
gree of  the  labour  and  care  of  navigating  the  ship."*  On  the 
other  hand  Dr.  Gilchrist,  who  wrote  particularly  on  the  me- 
dical use  of  sea  voyages,  extols  them  in  the  highest  terms, 
as  a  remedy  for  phthisis;  and  relates  many  cases  to  prove  the 
justice  of  his  encomiums.  He  asserts  that  in  some  instances 
a  voyage  of  a  few  hours  has  accomplished  the  most  marvel- 
ous change  in  the  disease  for  the  better.  Dr.  Rush,  in  speaking 
of  a  change  of  climate  as  a  cure  for  consumption,  says,  "  I  do 
not  recollect  an  instance  of  its  having  succeeded,  except  when 
it  has  been  accompanied  by  exercise,  as  in  travelling,  or  by 
some  active  laborious  pursuit;**!  and  with  respect  to  travelling 


*  Inquiries,  vol.  ii.  p.  64,  on  Pulmonarj'  Consumption, 
t  Ibid. 


144 

at  least  in  part,  from  the  effects  of  our  climate,  and 
might  be  cured  or  relieved   by  a  change  of  air* 

by  land,  he  has  the  following  remarks:  "  journies  have  often 
performed  cures  in  the  consumption,  but  it  has  been  chiefly 
when  they  have  been  long,  and  accompanied  by  difficulties 
which  have  roused  and  invigorated  the  powers  of  the  mind 
and  body."*  Cullen  believes  it  probable  that  some  benefit 
would  be  derived  from  the  great  purity  and  more  equal 
temperature  of  sea  air  than  that  of  land,  in  consumption.  Dr. 
Gourlay  of  Madeira  says,  that  the  itinerant  consumptive 
patients  who  visit  that  island  for  their  health,  seldom  re- 
cover; but  attributes  this  to  the  backwardness  which  people 
feel  to  repair  thither,  until  the  disease  has  gained  such  an  as- 
cendancy, that  neither  change  of  climate  nor  any  other 
remedy  could  have  any  good  effect.  I  believe  there  are  few 
points  in  medicine  that  have  undergone  more  disputation  and 
admitted  more  contrariety  of  reasoning  and  opinion,  than  the 
curableness  of  pulmonary  consumption,  and  the  efficacy  of  a 
change  of  climate,  travelling,  and  sea  voyages.  It  is,  certainly, 
not  for  me  to  presume  at  an  attempt  even  to  reconcile  the 
jarring  testimonies  of  venerable  and  eminent  authorities.  But 
as  I  have  in  a  preceding  note,  when  speaking  of  the  general 
efficacy  of  sailing  at  sea,  in  the  treatment  and  cure  of  diseases, 
asserted  that  I  had  seen  decided  advantages  resulting  from 


Inquiries,  voT.ii.  p.  64,  on  Pulmonary  Consumption. 


145 

These  fall  particularly   on  the  abdominal   viscera, 
especially  the  stomach  and  intestines,  and  greatly 

it,  I  will  now  mention  one  or  two  cases  of  pulmonary  con- 
sumption which  I  then  had  in  view.  Previously  to  doing  this 
however,  it  may  not  be  irrelevant  to  remark,  in  favour  of  the 
sea  life  upon  consumptive  people,  some  facts,  which  prove 
that  the  disease  is  rarely  incident  to  ^hat  life.  Dr.  Lind* 
says,  "that  out  of  5741  sailors,  who  were  admitted  into  the 
Naval  Hospital  at  Haslar,  near  Portsmouth,  in  two  years,  only 
360  of  them  had  consumptions;  and  in  one  fourth  of  these,"  he 
continues,  "  it  was  brought  on  by  bruises  or  falls."  Hence  it 
may  be  concluded,  that  the  exercise  of  sailing  invigorates 
the  lungs,  and  fortifies  them  against  accidents.  In  addition 
to  this  fact,  I  may  state  that  out  of  1045  patients  who 
came  under  my  care  from  the  1st  of  June  1809  to  the  first  of 
June  1811,  from  among  four  hundred  men  exposed  to  a  va- 
riety of  climates  in  different  parts  of  the  United  States,  in 
the  bay  of  Biscay,  the  British  Channel,  the  Atlantic  ocean, 
and  in  different  sea-port  towns,— there  were  only  mjc  cases  of 
pulmonary  consumption.  These  six,  exclusive  of  four  other 
cases  of  phthisis,  received  from  a  French  hospital.  The 
record  book  from  which  1  take  this  account,  exhibits  a  multi- 
farious variety  of  diseases;  among  them  many  cases  of  pleu- 
risy, and  nearly  three  hundred  of  catarrh,  which  so  frequently 
causes  consumption.  It  appears  then  from  this  fact,  that  the 
'  "  * ' '  II  I  I.  ■      I  i»i* 

*  Essay  on  the  means  of  preserving  the  Health  of  Seamen. 

T 


14a 

obstruct  their  functions.  Hence  they  are  not  only 
experienced   in  those  parts,  but  affect   the  whole 

disease  of  phthisis  pulmonalis  is  not  only  a  rare  complaint  at 
sea,  but  that  the  acute  diseases  which  so  frequently  terminate 
in  or  produce  it  on  shore,  have  not  the  same  fatal  tendency 
when  they  occur  under  the  influence  of  the  sea  air. 

Of  the  four  cases  I  have  just  alluded  to,  I  may  remark,  that 
two  out  of  the  four  died  in  a  few  weeks  after  they  were  re- 
ceived on  board  from  the  hospital.  The  other  two  recovered. 
These  patients  were  evidently  in  a  deep  consumption  of  the 
lungs.  Every  symptom  that  characterizes  this  complaint, 
was  evident  in  each  of  ihem.  The  passage  across  the  channel 
considerably  relieved  them,  and  in  the  course,  one  of  four  and 
the  other  of  six  weeks  of  the  voyage,  both  entirely  recovered. 
The  recovery  of  these  patients  was  as  unexpected  to  me  as  it 
was  to  themselves;  and  I  believe  their  only  hope  in  coming  on 
board  was,  that  they  might  survive  long  enough  to  reach  their 

native  shores^  and  die  with  their  friends. 
f 

Since  writing  the  note  containing  a  quotation  from  Dr.  Gor- 
don's letter  respecting  the  climate  of  Madeira,  the  work  of 
Dr.  Gourlay  has  fallen  into  my  hands.  This  writer  men- 
tions,* the  disease  of  phthisis  pulmonalis  as  an  endemick  of 


*  Observations  on  the  Natural  History,  Climate,  and  Diseases  of  Madeira, 
daring  a  period  of  eighteen  years,  by  Wm.  Gourlay,  M.  D.  London,  1811,  • 


147 

system,  and  often  produce  many  serious,  and  indeed 
most  obstinate  disorders.   But  we  shall  here  only 

.  that  island.  He  says  its  fatality  is  prodigious  among  the  inha- 
bitants. He  reprobates  the  practice  of  sending  consumptive 
patients  to  the  island,  so  far  advanced  in  the  disease  that  their 
death,  which  is  inevitable,  can  only  be  protracted  for  some 
time.  He  thinks  the  summer  in  that  climate  too  hot  for  con- 
sumptive persons.  "  Under  all  circumstances,"  says  Dr.  Gour- 
lay,*  *'in  Madeira,  the  fittest  season  for  invalids,  is  from 
November  to  the  beginning  of  June.  This  was  the  opinion  of 
the  late  Dr.  Cullen,  who,  in  his  lectures  on  this  disease,  was 
wont  to  observe,  in  directing  a  change  of  climate,  that  it  was 
as  pernicious  for  phthisical  patients  to  pass  the  summer  in  a 
very  warm  climate,  such  as  Madeira,  as  to  remain  in  England 
in  winter;  and  indeed  that  the  most  benign  climate  in  such 
cases,  was  found  in  the  south  of  England,  and  in  the  winter  of 
southern  latitudes."  From  the  assertion  of  Dr.  Gourlay  re- 
specting the  fatality  of  consumption  in  Madeira,  and  the  ex? 
treme  frequency  of  the  disease  among  the  inhabitants  who 
have  never  been  out  of  the  island,  I  think  it  is  evident,  that  the 
climate  must  contain  some  vice  that  is  inimical  to  the  con- 
sumptive. How  that  place  received  the  high  character  it  has 
obtained  among  physicians,  and  among  consumptive  patients, 
I  know  not:  certain  it  is,  that  it  is  wholly  unmerited. 

Since 

*  Observations  on  the  Natural  History,  &c.  of  Madeira,  by  Dr.  Gourlay^  p.  93. 


148 

treat  of  two  complaints  of  this  nature:  viz.,  of  hypo- 
chondriasis  and  gout. 

Since  the  above  went  to  press,  the  "  Introductory  Dis- 
course"* of  Mr.  De  Witt  Clinton,  of  New  York,  has  fallen  into 
my  hands.  From  it  I  shall  make  the  following  interesting  ab- 
stract, and  I  will  venture  to  do  so,  without  any  other  apology 
than  to  say  the  matter  is  very  pertinent  to  the  subject  of  this 
work,  and  is  already  so  condensed  into  a  few  well-written  pa- 
ragraphs that  I  could  not  give  the  substance  of  the  remarks, 
without  detailing  them  in  the  words  of  the  author. 

"  The  comparative  mortality  of  London  has  not  only  greatly 
diminished  within  the  last  fifty  or  sixty  years,  but  a  number 
of  diseases  which,  previous  to  that  period,  were  very  destruc- 
tive, have  almost  entirely  disappeared;  for  instance,  the  plague, 
the  rickets  and  the  scurvy:  while  others  that  were  formerly 
considered  very  mortal,  are  now  viewed  as  no  longer  formida- 
ble; such  as  the  small  pox,  the  dysentery  and  intermittent 
fevers. 

«  Other  diseases,  supposed  to  be  less  dependent  on  the  phy- 
sical than  on  the  moral  and  political  changes  which  Great 
Britain  has  undergone,  have  increased  in  number  and  fatality; 
and  are  attributed,  chiefly,  to  the  increase  of  manufactures; 


*  Delivered  before  the  Literary  and  Philosophical  Society  of  the  State  of 
New  York,  on  the  4th  of  May,  18U. 


14^ 

and,  consequently,  of  the  number  of  sedentary  and  otherwise 
unwholesome  occupations;  to  the  augmentation  of  the  national 
wealth,  and  with  it,  of  luxury  and  high  feeding;  and  to  the 
fluctuations  in  the  conditions  of  life,  attendant  on  the  spirit  of 
commercial  speculation.  To  the  first  of  these  sources  is  as- 
cribed, in  part,  the  regular  increase  of  the  consumption,  dur- 
ing the  last  century;  to  the  second,  the  more  inconsiderable, 
but  scarcely  less  regular,  increase  of  apoplexy,  palsy,  gout) 
and  sudden  deaths;  and  to  the  last,  the  more  frequent  occur- 
rence of  insanity  in  its  different  forms:  and  the  increase  of  in- 
temperance and  vice,  in  a  large  and  populous  city,  doubt- 
less contributes  much  to  the  augmentation  of  all  these  dis- 
eases. 

"  Dr.  Heberden  states  the  proportion  of  these  three  classes 
of  disease,  at  the  beginning,  middle,  and  end,  of  the  eighteenth 
century,  to  have  been  as  follows: 

Beginning. 
Consumption,  3,000 

Palsy,  apoplexy,  &c,         157 
Lunatic,  "  27 

« If  we  compare  the  mortality  from  consumption,  at  those 
three  periods,  with  the  total  mortality,  we  find,  that  in  1669 
the  deaths,  from  consumption,  were,  to  the  whole,  as 
1         to  about         6  2 

In  1749,  1  5  5 

1799,  I  3  8 

1808,  1  3  6 

"The 


Middle. 

End. 

4,000 

5,000 

280 

300 

75 

70 

150 

"  The  reports  of  consumption,  in  other  parts  of  Great  Britain, 
correspond,  in  a  great  degree,  with  the  accounts  of  its  preva- 
lence ill  London,  and,  therefore,  render  this  ascription  of  its 
causes  and  origin  unbatisfactory. 

"  Dr.  Lettsom,  however,  in  a  letter  to  Dr.  Hosack,  on  the 
diseases  of  London,  (yifner.  Med.  and  Phil.  Reg.  vol.  2.)  says, 
*'  Whilst  the  phthisis  p\jlmonalis  is  rapidly  increasing  in 
America,  and  in  the  European  continent,  it  is  diminishiiig 
here.  The  croup  is  less  fatal,  in  consequence  of  the  imme- 
diate and  free  use  of  the  lancet,  and  of  leeches,  with  pur- 
gatives, than  heretofore;  nor  is  angina  scarlatina  either  so 
frequent  or  so  fatal.  The  typhus  is  almost  extinct,  and  the  cho- 
lera morbus  is  unfrequent;  and,  as  far  as  my  experience  ex- 
tends, the  syphilis  is  milder  or  easier  cured;  and,  lately,  such 
has  been  the  prolongation  of  health  and  life  as  to  lessen  the 
premiums  of  insurance  considerably." 

"Out  of  19,954  deaths,  in  London,  in  1808,  5,220  are  as- 
cribed to  the  consumption.  The  christenings,  in  that  year, 
were  19,906,  nearly  equal  to  the  burials. 

"  In  1809,  the  healthiest  year  which  London  ever  enjoyed, 
there  were  16,680  deaths,  4,570  of  which  were  produced 
by  the  consumption;  the  number  of  christenings  was  19,612, 
making  the  excess  of  births  above  tTie  deaths  nearly  3,000. 
(See  the  London  Annual  Medical  Review  and  Register,  for 
1808  and  1809») 

"  Dr.  James 


151 

*<  Dr.  James  E.  Smith  says,  that  "  in  Italy,  consumptions 
are  found  to  be  very  contagious,  thoiijjh  less  evidently  so  in 
England."  It  is  intimated,  if  my  memory  serves  me,  in  that 
excellent  work,  the  Emporium,  that  the  general  use  of  cotton 
shirts,  8cc.  may  have  a  pernicious  influence  in  producin*  the 
disease.  Its  increased  fatality  in  Europe,  as  well  as  in  America, 
is,  probably,  owing  to  a  complication  of  causes;  and,  indeed, 
the  periodical  prevalence  and  disappearance  of  certain  dis- 
eases, must  be  classed  among  those  aixana  which  providence 
has  concealed  from  man. 

«'  Salubrious  as  the  climate  of  Madeira  is  generally  reck- 
oned, we  find,  that  even  there  pulmonary  diseases  cut  ofF  a 
great  number  of  the  inhabitants.  Of  the  various  districts  of 
North  America,  New  York  has  been  considered,  by  many,  as 
being  especially  favoured  with  regard  to  the  mildness  of  its 
seasons;  and  the  changes  of  its  weather  were  referred  chiefly 
to  the  diff*erence  in  the  prevailing  winds.  Among  a  series 
of  interestng  remarks  on  the  climate  and  diseases  of  New 
York,  made  by  Lieutenant-governor  Golden,  about  seventy 
years  ago,  and  inserted  in  the  American  Medical  and  Philo- 
sophical Register,  vol.  I.,  this  medical  philosopher  observes, 
"  The  air  of  the  country  being  almost  always  clear,  and  its 
spring  strong,  we  have  few  consumptions,  or  diseases  of  the 
lungs."  "  People  inclined  to  be  consumptive  in  England,  are 
often  perfectly  cured  by  our  fine  air;  but  if  there  be  ulcei's 
formed  they  die.  The  climate  grows  every  day  better,  as  the 
country  is  cleared  of  the  woods;  and  more  healthy,  as  all  the 
people  that  have  lived  long  here  testify.  This  has  even  been  sen- 
sible to  me,  though  I  have  been  but,  about  twelve  years  in  this 


15Q 


country;  /,  therefore,  doubt  not  but  it  will,  in  time,  become  one  of 
the  most  agreeable  and  healthy  climates  on  the  face  of  the  earth. 
As  it  is  at  present,  I  prefer  it  to  the  climate  of  England,  and, 
I  believe,  most  people  that  have  lived  any  considerable  time 
here,  and  have  returned  to  England,  will  confirm  this." 

"  If  the  climate  of  New  York  was  formerly  thus  mild 
and  healihy,  and  a  constant  amelioration  in  its  tempera- 
ture is  consequent  upon  our  numerous  settlements  and 
improvements,  as  has  been  maintained  by  many  distin- 
guished writers,  to  what  shall  we  ascribe  the  extraordi- 
nary mortality  occasioned  by  pulmonary  consumption  at  the 
present  day.  None  will  deny  this  disorder  to  be  influenced  by 
climate,  and  independent  of  eflccts  arising  from  particular 
employments,  and  modes  of  living;  but  we  will,  perhaps,  find 
the  most  satisfactory  answer  to  this  question,  in  considering 
phthisis  in  its  various  forms  as  the  off'spring  rather  of  in- 
creased dissipation,  of  great  imprudence  in  dress,  and  of  con- 
sequent exposure  to  sudden  changes  of  temperature,  than  of 
any  peculiarity  in  our  climate  and  seasons."* 


Since  writing  note  18,  I  have  received  a  letter  from 
Dr.  Gerard  Dayers,  formerly  surgeon's  mate  of  the  United 
States,  when  I  was  surgeon  of  that  ship.  It  enables  me  to  add 
the  case  of  a  favourable  termination  of  a  wound  into  the  ca- 

*  Note  N.  N.  p.  1«0. 


153 

vity  of  the  lungs,  which  I  would  have  related  in  that  note,  but 
could  not  at  that  time  assert  positively  the  favourable  nature 
of  the  result.  I  however  will  subjoin  it  in  this  place,  though 
not  immediately  connected  with  ihe  preceding  matter.  I 
was  called  while  on  shore,  to  see  a  man  by  the  name  of 
Tindell,  then  one  of  the  United  States*  boat's  crew.  He  had 
been  wounded  in  three  or  four  places  by  a  pretty  large  couteau- 
de-c/iasse,  in  an  affray  with  a  Portuguese  sailor.  I  found  him 
lying  on  his  left  side  in  Dr.  Balfour's  shop  in  Norfolk,  whither 
he  had  been  carried  by  some  of  his  companions.  Upon  exami- 
nation of  his  wounds,  I  perceived  that  the  severest  perforated 
the  left  lobe  of  tlie  lungs.  Through  this  wound  he  was  bleed- 
ing freely,  and  also  expectorating  blood.  After  taking  a  good 
deal  of  blood  from  his  arm,  I  had  him  removed  to  comfortable 
quarters  in  Water  street,  where  I  again  bled  him  in  the  evening 
and  very  largely  on  the  following  morning.  He  was  kept  ex- 
ceedingly low  for  the  space  perhaps  often  days,  and  as  I  was 
about  to  sail  in  another  ship  for  France,  I  left  him  with  the 
most  favourable  symptoms  in  the  careof  one  of  my  mates,  who 
from  his  experience  and  knowledge  was  well  able  to  give  him 
every  judicious  and  necessary  assistance.  I  accordingly  sailed 
the  next  day,  and  heard  no  more  after  my  return,  of  the  par- 
ticulars of  his  fate,  than  that  he  had  recovered.  The  case  ex- 
cited considerable  interest  among  the  physicians  of  Norfolk, 
from  whom  I  frequently  had  inquiries  respecting  his  condition; 
it  must  therefore  be  well  known  to  those  gentlemen,  as  I 
am  sure  it  is  to  commodore  Decatur,  and  the  officers  of  his 
ship.  The  following  is  a  brief  account  of  this  man's  case,  after 
I  left  him  in  the  hands  of  Dr.  Dayers,  (now  surgeon  of  the 
Congress,)  from  a  late  letter  received  from  that  gentleman. 

u 


154 

*•  U.  S.  Frigate  Congress,  Portsmouth,  N.  H., 
March  7th,  1815. 

*  *  *  *  "  As  respects  the  surgieal  case,  I  lost  all  my  books, 
notes,  8cc.  at  the  time  the  English  made  an  attack  on  the  U.  S. 
ship  Adams  at  Hampden  in  Maine,  but  as  far  as  memory  will 
assist  me,  I  will  give  you  the  symptoms  and  mode  of  treatment 

"  In  the  case  of  Tindell,  who  was  wounded  in  the  lungs  by 
a  sword,  the  breathing  was  very  much  obstructed,  there  was 
bloody  expectorationv&c;  he  was  bled  onee  after  he  came  un- 
der my  care:  in  conjunction  with  this  important  remedy,  he 
was  kept  perfectly  at  rest,  cooling  laxatives  were  adminis- 
tered, and  a  low  diet  observed.  Under  this  treatment  he  got 
perfectly  well,  since  then  I  have  heard  nothing  of  him. 

V 

**  I  hope  you  will  pardon  the  concise  account  that  I  have 
given  you;  but  what  I  have  mentioned  is  strictly  so,  as  far  as 
my  recollection  serves  me.  The  treatment  previous  to  his 
coming  under  my  particular  care,  I  have  very  little  know- 
ledge of:  but  I  suppose  you  have,  as  you  attended  him  for  a 
short  time. 

"  Yours,  with  great  esteem, 

«  GERARD  D AYERS." 

The  instrument  by  which  the  wound  just  related  was  made, 
fell  into  my  hands.  It  was  at  least  one  inch  broad,  and  very 
thick  on  the  back  edge,  at  the  point  up  to  which  it  must  have 
been  thrust  into  the  body.  The  perfect  and  speedy  recovery 
of  this  man,  is  another  convincing  proof  that  violent  wounds 
may  be  made  into  the  lungs,  without  inducing  pulmonary 
consumption,  or  any  other  material  injury. 


155 


sp:ction  hi. 


Of  the  causes  of  Hypochondria,  especially  its  origin  from 
the  effects  of  climate,  diet,  and  mode  of  life.  Its  various 
symptoms.  Its  connection  with  the  haemorrhoidal  flux 
and  its  affinity  to  this  disease,  deduced  from  the  similarity 
of  its  causes.  The  general  absence  of  any  praeternatural  ap- 
pearances in  the  dissection  of  the  dead  bodies  of  hypochon- 
driacks.  Sometimes  turgescence  in  the  mesenterick  veins 
observable.  The  different  remedies  for  this  disease.  The  be- 
neficial effects  of  riding  on  horseback,  especially  when 
conjoined  with  a  change  of  climate. 

Hypochondria  is  well  known  to  all  physicians, 
for  there  is  not  any  chronick  disease  scarcely,  of 
more  frequent  occurrence  than  this,  at  least  in  the 
island  of  great  Britain.  Various,  and  indeeed  innu- 
merable symptoms,  both  of  mind  and  body,  accom- 
pany this  complaint.  But  especially  a  lassitude  and 
torpor  of  the  whole  system,  depression  of  spirits,  fear, 
and  anxiety,  together  with  a  derangement  of  the  func- 
tions of  the  stomach  and  intestines.  This  diversified 
disease  appears  to  originate  from  the  effects  of  our 
climate;  for  it  is  most  frequent  in  cold  moist  coun- 
tries; while  in  those  that  are  temperate  or  warm,  it  is 
either  very  rare,  or  altogether  unknown.  It  is  ob- 


156 

served  also,  that  the  hypochondriack  are  much  better 
in  summer  than  in  winter.  Hence  it  is  probable  that 
the  disease  might  be  relieved  or  cured  by  a  change 
of  climate.  Indeed  it  is  difficult  and  perhaps  impos- 
sible to  assign  a  satisfactory  and  accurate  reason  for 
all  the  symptoms  which  occur  in  this  disease.  For 
many  have  a  connexion  with  nervous  affections,  the 
nature  of  which  is  not  sufficiently  investigated  to  ena- 
ble us  to  understand  the  complaint.  Many  depend  on  a 
certain  incomprehensible  sympathy,  which  exists  be- 
.tween  the  different  parts  of  the  system,  and  between 
the  mind  and  the  body.  But  this  sympathy  is  veiled 
in  the  darkest  obscurity.  Such  symptoms,  therefore, 
I  shall  not  attempt  to  explain.  I  shall  endeavour  only 
to  investigate  the  sensible  causes  of  the  disease,  both 
proximate  and  remote;  and  to  show  from  them  and 
from  analogy  of  the  effects  of  such  things  as  do  harm 
or  good,  how  the  complaint  may  be  cured  by  a 
change  of  climate,  or  at  least  that  it  can  be  rendered 
milder. 

It  can  scarcely  be  doubted  that  the  proximate 
cause  of  this  disease  exists  in  the  alimentary  canal; 
for  the  most  of  the  symptoms  by  which  hypochon- 
driacks  are  troubled,  evidently  arise  from  the  dis- 
turbed functions  of  the  stomach  and  intestines.  Such 


157 

as,  anorexia,  nausea,  vomiting,  eructation,  rumina- 
tion, cardialgia,  gastrodynia,  flatulency,  tormina, 
sometimes  diarrhoea,  but  ofteaer  costiveness  of  the 
bowels.  All  these  are  to  be  attributed,  without 
doubt,  to  debility  or  want  of  tone  in  th'j  alimentary 
canal.  The  affections  of  the  mind  too,  which  consti- 
tute so  considerable  a  portion  of  this  complaint  at 
least  in  most  cases,  are  clearly  produced  by  the  same 
weakness  of  the  stomach  and  intestines;  although 
sometimes,  the  affections  of  the  mind  are  observed 
to  bring  on  debility  of  the  stomach  and  intestines, 
and  true  hypochondria. 

A  very  difficult  question  now  presents  itself:  if 
certain  affections  of  the  mind  aris«  from  weakness 
of  the  intestines,  how  happens  it,  that  the  debility 
often  occurs,  without  such  mental  disorders?  For 
there  are  many  instances  where  the  sick  are  dis- 
tressingly troubled  with  all  the  diseases  of  the  stomach 
and  intestines  which  happen  to  hypochondriacks, 
while  the  mind  is  in  no  way  affected.  I  confess  my 
inability  to^  solve  this  difficulty:  indeed  I  doubt 
whether  it  can  be  explained  until  the  reciprocal  ac- 
tion of  the  mind  and  body  upon  each  other,  is  more 
accurately  investigated.  It  has  never  been  properly 


158 


understood,  how  the  diseases  of  the  stomach  affect 
the  mind;  it  is  hardly  to  be  expected  therefore  that  a 
reason  can  be  given  why  this  should  happen  only  in 
some  cases.  Perhaps  a  peculiar  disposition  in  the 
nervous  system,  or  in  the  mind  itself  is  necessary, 
in  order  that  those,  affections  may  be  produced. 
What  this  disposition  is,  I  confess  I  do  not  know.  Yet 
it  is  evident  that  the  affections  of  the  mind  often  de- 
pend on  the  morbid  state  of  the  stomach  and  intes- 
tines; since  it  generally  happens  that  when  this  dis- 
eased condition  is  removed,  the  mind  is  restored  to 
its  former  healthiness. 

We  have  said  that  the  disease,  or  rather  the  cause 
of  the  diseases  of  the  intestines  is  debility,  or  want 
of  tone.  Many  reasons  confirm  this  opinion.  Those 
symptoms  above  enumerated,  evidently  indicate  a 
debility  of  the  stomach  and  intestines;  a  weakness  of 
the  whole  system  accompanies  the  disease,  and  not 
unfrequently  appears  to  produce  it;  many  causes 
which  debilitate  the  whole  body,  but  especially  the 
intestines,  often  bring  on  the  disease;  and  whatever 
invigorates  the  intestines  or  the  general  system,  is 
beneficial  to  hypochondriacks.  But  besides  these, 
if  I  am  not  mistaken,  another  evil  often  exists  in 


159 

the  system,  which  increases  the  debility  and  want  of 
tone  in  the  alimentary  canal,  as  well  as  the  hypochon- 
dria, and  perhaps  also  it  might  bring  on  the  disease; 
namely,  a  tardy  circulation  of  the  blood,  and  also 
congestion  in  the  abdomen.  If  a  free  and  natural  dis- 
tribution of  blood  is  necessary  for  sustaining  the 
health  and  strength  of  the  whole  system,  or  any  of 
its  parts,  it  may  easily  be  credited  that  from  an  im- 
peded motion  of  this  fluid  in  the  abdominal  viscera, 
the  intestines  would  receive  such  an  injury,  that  they 
would  be  rendered  liable  to  various  disorders.  Or,  if 
they  should  already  have  been  debilitated  and  dis- 
eased, and  the  distribution  of  the  blood  disturbed, 
it  is  probable  that  the  injury  would  fall  especially  on 
them.  Finally,  it  is  evident  that  if  the  circulation  of 
the  blood  should  languish  in  consequence  of  a  want 
of  exercise,  or  from  other  causes,  although  it  would 
affect  the  whole  system,  yet  the  evils  arising  from  it 
would  be  particularly  felt  in  the  abdomen;  for  the 
motion  of  the  venous  blood  is  naturall}'  most  slow 
there,  on  account  of  the  long  circuit  it  makes  through 
the  liver  before  it  returns  to  the  heart. 

This  opinion,  that  hypochondria  arises  from  a  tardy 
circulation  and  also  congestion  of  the  blood  in  the 
abdomen,  is  by  no  means  inconsistent  with  reason, 


160 

and  we  shall  now  see  how  it  is  confirmed  by  observa- 
tion of  the  remote  causes  of  the  disease,  and  those 
things  which  are  beneficial  or  hurtful  to  the  hypo- 
chondriack. 

The  different  causes  which  bring  on  hypo- 
chondria, are  observed  to  injure  directly  and  imme- 
diately, the  stomach  and  intestines.  Others  again 
impede  in  the  first  place  the  motion  of  the  fluids,  and 
debilitate  in  this  way  perhaps,  the  abdominal  viscera, 
and  in  our  opinion  cause  hypochondria.  Some  indeed, 
have  evidently  both  those  effects.  We  have  said  that 
a  cold  moist  climate,  like  that  which  occurs  in  our 
northern  countries,  especially  in  the  winter  season, 
produces  a  disposition  to  hypochondria.  The  most 
manifest  effect  of  such  a  climate  is,  to  check  the 
perspiration  and  hinder  the  distribution  of  the  fluids 
to  the  surface  of  the  body.  Hence  internal  congestion 
is  to  be  feared.  I  do  not  intend  to  deny,  that  a  cold 
and  humid  climate  can  directly  affect  the  stomach 
and  nervous  system,  and  finally  the  mind  itself,  even 
if  it  should  not  disturb  the  motion  of  the  fluids.  It  is 
known  that  moist  air  relaxes  and  weakens  the  mus- 
cular fibres  of  the  whole  body.  It  is  not  surprising 
therefore,  that  the  stomach  and  intestines  should 
suffer  from  the  same  effects.  The  inhabitants  of  damp 


161 

cold  countries  are  languid,  inactive,  and  inclined  to 
melancholy;  for  that  reason  perhaps,  they  are  liable 
to  this  disease.  Nor  is  it  unreasonable  to  attribute 
this  distressing  disposition  of  mind  and  body  to  ob* 
structed  perspiration.  For  Sanctorius  has  declared  in 
his  established  aphorisms,  that  cheerfulness  of  mind 
is  produced  during  a  very  free  perspiration  by  the  sur- 
face of  the  body;  and  on  the  other  hand,  that  a  sense 
of  heaviness  in  the  body  and  sadness  of  mind  is  per- 
ceived when  the  perspiration  is  obstructed.  Almost 
all  persons,  however  healthy  and  robust  they  may  be, 
and  free  from  the  hypochondriack  disease,  observe 
the  most  evident  effects  both  on  the  mind  and  body, 
to  follow  different  changes  of  the  weather.  When  it 
is  temperate,  dry  and  clear,  the  body  receives  new 
strength  and  activity,  and  the  mind  increased  cheer- 
fulness. But  on  the  other  hand,  when  the  atmosphere 
is  cold,  humid,  cloudy  and  dark,  the  body  becomes 
weak  and  languid,  and  the  mind  dull  and  gloomy. 
These  differences  are  perhaps  to  be  attributed  to 
the  effects  of  climate  on  the  nervous  system;  for 
there  is  no  doubt  but  that  it  does  exert  powerful 
effects  in  this  way.  But  if  I  be  not  mistaken,  the 
greatest  part  of  these  differences  in  the  feelings  is  to 
be  ascribed  to  the  disturbed  distribution  of  the  fluids; 
X 


162 

for  if  this  is  properly  promoted  by  a  due  degree  of 
exercise,  neither  sadness  of  mind  nor  lassitude  of 
body  is  for  the  most  part  produced  by  the  effects  of 
a  cold  moist  climate  upon  the  nervous  system. 

Another,  and  indeed  the  most  frequent  cause  of 
this  complaint,  is  an  indolent  and  sedentary  life.  Most 
men  devoted  to  study,  or  occupied  with  other 
business,  which  requires  a  continual  and  close  ap- 
plication of  the  mind,  and  hardly  any  exercise  of 
body,  are  more  or  less  troubled  with  this  disorder. 
This  kind  of  life  can  do  harm  in  two  ways,  and  pro- 
duce a  disposition  to  hypochondria:  in  the  first  place, 
a  sluggish  motion  of  the  blood  is  produced  by  it,  in 
consequence  of  a  want  of  natural  exercise:  for  phy- 
sicians know,  that  the  action  of  the  muscles  is  ne- 
cessary, in  order  to  promote  duly  the  circulation  of 
the  blood.  Hence  also  perspiration  and  a  determina- 
tion to  the  surface  is  diminished;  consequently  ple- 
thora is  produced  in  the  system;  congestion  in  the  in- 
ternal parts;  and  we  have  already  shown  that  the  evils 
arising  from  this  source  would  especially  affect  the 
abdomen  in  this  period  of  life.  Besides,  when  the 
muscles  are  not  properly  exercised,  they  soon  lose 
their  former  and  natural  strength,  the  moving  powers 


163 

in  a  sedendary  life,  necessarily  languish,  and  the 
whole  body  becomes  debilitated;  hence  perhaps  the 
stomach  and  intestines,  by  sympathy  or  consent,  de- 
rive a  similar  debility  or  want  of  tone.  But  my  opi- 
nion is,  that  hypochondria  arising  from  a  sedentary 
life,  is  rather  to  be  attributed  to  an  obstructed  dis- 
tribution of  the  fluids  to  external  parts,  than  to  a  weak- 
ness and  want  of  tone  in  the  muscles;  though  this 
want  of  tone  may  doubtless  increase  the  evil.  For  in 
warm  countries,  where  the  perspiration  and  deter- 
mination to  the  surface  is  sufiiciently  promoted  by 
the  heat  of  the  air  alone,  hypochondria  rarely  occurs, 
although  debility  and  want  of  tone  are  common 
enough,  and  the  inhabitants  do  not  use  much  ex- 
ercise. 

Certain  affections  of  the  mind  which  we  call  de- 
pressing passions,  especially  grief,  and  continual  and 
distressing  anxiety,  often  cause  hypochondria.  But 
it  is  well  known,  that  all  serious  affections  of  the 
mind  affect  the  stomach  in  some  degree,  and  vice 
versa,  the  mind  is  disturbed  by  the  different  diseases 
of  the  stomach.  For  it  has  been  observed,  that  sad- 
ness of  mind,  and  other  effects  of  this  nature,  not 
only  debilitate  in  a  surprising  manner  the  stomach 


164 

and  whole  body,  but  also  greatly  obstruct  perspi- 
ration.  When  therefore,  the  motion  of  the  blood  be- 
comes languid,  and  the  deter mihation  to  the  surface 
is  in  this  manner  diverted,  and  the  stomach  and  in- 
testines from  their  consent  with  the  mind  are  debili- 
tated by  the  same  cause:  is  it  not  probable  that 
congestion  in  the  abdominal  vicera  will  succeed  that 
debility,  and  would  be  the  cause  of  hypochondria  fol- 
lowing? 

Many  causes  in  fact  produce  this  disease,  by  debi- 
litating the  stomach,  the  intestines,  and  the  general 
system,  which  do  not  appear  directly  or  particularly 
to  affect  the  distribution  of  the  fluids.  Such  are  large, 
and  especially  slaw  evacuations,  the  menstrual  flux, 
fluor  albus,  sometimes  excessive  venery:  these  give 
rise  to  a  debility  of  the  whole  system.  Other  causes 
particularly  weaken  the  stomach  and  intestines:  such 
are  the  excessive  use  of  tea,  tobacco  or  opium,  and 
of  other  narcoticks;  or  the  frequent  repetition  of  the 
more  powerful  emeticks  and  catharticks,  diarrhoea  or 
continual  binding  of  the  bowels. 

Other  causes  however,  which  produce  hypochon- 
dria or  at  least  a  disposition  to  it,  evidently  appear  to 


165 

cause  a  sluggish  motion  and  congestion  of  blood  in 
the  abdomen.  Plethora  without  doubt  in  many  cases 
contributes  not  a  little  to  produce  this  disease.  For 
men  who  use  a  full  and  generous  diet,  and  lead  an 
indolent  and  sedentary  life,  are  very  much  inclined 
to  hypochondria,  and  it  can  hardly  be  doubted  but 
that  a  plethorick  state  may  exist  in  the  system  of  such 
persons,  and  may  create  the  greatest  part  of  the  dis- 
order; especially  when  we  consider  the  remedies 
which  give  relief  to  such  patients.  For  a  lighter 
and  more  spare  diet,  or  one  consisting  of  fruits; 
frequent  and  constant  exercise,  and  sometimes  the 
loss  of  blood, — greatly  relieve  them;  and  all  these  evi- 
dently and  directly  diminish  or  remove  plethora.  We 
have  before  explained  why  plethora,  if  any  exists  in 
the  system,  particularly  shows  itself  in  the  abdomen. 
For  hypochondria  only  occurs  in  advanced  age:  in 
infancy  it  is  altogether  unknown;  it  is  most  frequently 
met  with  after  the  thirtieth  or  thirty-fifth  year. 

The  disease  also  not  unfrequently  arises  from 
those  tumours  in  tl^  spleen  or  liver,  which  are  some- 
times observed  after  intermittents  that  have  been 
imperfectly  cured.  Tumours  of  this  kind  evident!} 


166 

obstruct  the  free  motion  of  the  blood  in  the  abdomen, 
and  consequently  produce  congestion. 

It  arises  too,  and  not  rarely,  from  a  haemorrhagick 
disposition,  when  the  haemorrhages  haie  ceased.  It 
appears  from  observations  that  those  who  have  had 
haemorrhages,  are  greatly  inclined  to  this  disease. 
Those  who  have  had  the  haemorrhoidal  flux  checked, 
are  particularly  liable  to  hypochondria.   And  from 
this  source  hypochondria  often  arises.    It  appears 
evident  to  every  one  that  a  suppression  of  that  flux, 
produces  a  congestion  of  blood  in  the   abdomen. 
There  is  a  very  remarkable  connexion  between  hy- 
pochondria and  the  hsemorrhoidal  flux:  the  same 
age;  the  same  climate  and  season  of  the  year;  the 
same  mode  of  living;  as  for  instance  a  full  and  gross 
diet,  and  an  indolent  and  sedentary  life,  a  plethorick 
habit,  a  haemorrhagick  disposition,  and  costiveness 
of  the  bowels, — equally  induce  both.  They  occur  not 
unfrequently  in  the  same  patient,  and  occasionally  at 
the  same  time;  and  hypochondria  is  often  produced 
by  a  suppression  of  the  haemorrhoidal  flux;   when 
that  is  restored,  this  in  its  turn  is  released.  But  the 
haemorrhoidal  flux  arises  without  doubt  from  con- 
gestion of  blood  in  the  abdomen:  from  this  fact  there- 


167 

fore,  another  argument  arises  which  tends  to  prove 
that  at  least  in  many  cases,  hypochondria  derives  its 
origin  from  the  same  source. 

Nothing  of  consequence  can  be  learned  on  this 
subject  by  dissecting  dead  bodies;  for  hypochondria, 
however  troublesome  and  difficult  of  cure  it  may  be, 
and  notwithstanding  it  distressingly  torments  many 
persons  during  the  greatest  part  of  life,  yet  it  is 
scarcely  ever  fatal,  unless  sometimes  when  it  brings 
on  other  diseases,  as  dropsy  for  example,  or  a  cachec- 
tick  state  of  the  system.  In  some  of  the  dead  bodies 
of  hypochondriacks  however,  a  congestion  of  blood 
has  been  plainly  observed  in  the  mesenterick  veins. 

There  is  every  reason  I  am  persuaded,  to  deduce 
two  principal  causes  of  hypochondria,  viz.  a  debility 
and  want  of  tone  in  the  stomach  and  intestines,  and 
a  congestion  of  blood  in  the  abdomen.  The  mode 
of  curing  the  disease  then,  according  to  this  theory, 
renders  it  necessary,  before  attempting  any  thing  else, 
to  invigorate  the  stomach  and  intestines,  remove  the 
congestion  of  blood  from  the  abdomen,  and  promote 
the  free  motion  and  distribution  of  this  fluid.  To  the 
first  intention,  many  remedies  are  adapted;  and  often 


168 

not  a  little  benefit  is  derived  from  tonick  medicines, 
cither  taken  internally  or  otherwise  applied.  Of  this 
kind  are  the  Peruvian  bark,  steel,  bitters,  the  cold 
bath.  But  these  remedies  rarely  effect  a  perfect  cure 
of  the  disease,  unless  others  are  at  the  same  time 
exhibited,  which  answer  the  other  intention  of  cure, 
namely,  to  restore  the  due  motion  and  distribution 
of  the  fluids.  Now  this  is  best  effected  by  exercise 
in  the  warm  air,  especially  by  riding  on  horseback, 
than  which  nothing  gives  greater  relief  to  those 
labouring  under  hypochondria.  The  commendations 
which  Sydenham  has  bestowed  upon  the  exercise  of 
riding  on  horseback,  as  a  cure  for  consumption, 
might  perhaps  be  more  properly  applied  to  the  hy- 
pochondria. It  does  not  only  effect  a  due  distribution 
of  the  fluids, — promote  the  motion  of  the  blood  to 
the  smallest  vessels  of  extreme  parts, — afford  activity 
to  the  moving  powers  of  the  system  and  to  the  whole 
body, — but  especially  benefits  the  stomach  and  the 
other  abdominal  viscera.  No  other  kind  of  exercise 
affords  such  concussion,  by  which  the  circulation  of 
the  blood  in  the  abdomen  is  equally  promoted,  and 
it  thus  seems  to  increase  the  peristaltick  motion  and 
strength  of  the  intestines.  Hence  all  the  excretions 
of  the  fluids  which  are  so  essentially  useful  for  the 


169 

digestion  of  food,  are  promoted,  and  the  nutriment 
is  properly  and  perfectly  concocted.  The  intestines 
being  rendered  healthy  in  this  way,  the  mind  by  its 
peculiar  sympathy  with  the  stomach,  receives  its  ac- 
customed activity  and  cheerfulness. 

This  important  remedy  is  rendered  still  more  effi- 
/  cacious  when  conjoined  to  a  change  of  climate.  Wc 
have  already  said  enough  with  regard  to  the  effects 
of  a  moderately  warm  climate,  in  promoting  the  due 
distribution  of  the  fluids,  which  we  have  endeavour- 
ed to  prove,  is  of  the  greatest  utility  also  in  hypo- 
chondria. But  since  this  disease  affects  the  mind  in 
a  great  degree,  and  often  derives  its  origin  from  it, 
it  is  evident,  that  a  temperate  and  pleasant  climate, 
and  indeed  a  change  of  place  itself,  would  be  ex- 
ceedingly useful  to  the  sick.  A  finer  climate  than 
that  of  our  own  country,  gayer  manners,  new  and 
pleasant  scenes,  all  occupy  the  mind  agreeably,  and 
delightfully  divert  the  imagination.  By  these  means 
also,  when  the  disease  has  but  just  begun  to  affect 
the  mind,  the  patient  would  experience  the  greatest 
relief  by  reason  of  the  sympathy  that  exists  be- 
tween the  mind  and  the  abdominal  viscera. 

Y 


170 

But  a  change  of  place  and  the  journey  itself,  be- 
sides the  benefit  arising  from  long  continued  exer- 
cise, produce  other  most  powerful  effects.  A  certain 
connexion  exists  between  distance  and  time,  estimat- 
ed by  the  remarkable  incidents  of  our  life,  which  ex- 
erts happy  effects  on  the  mind.  Travelling  (from  the 
number  of  interesting  occurrences  that  happen  al- 
most daily)  produces  similar  effects,  and  causes  an 
oblivion  of  our  sorrows,  just  as  the  lapse  of  years 
produces  sooner  or  later  relief  to  all  diseased  or 
melancholy  minds.  Distance  from  our  home,  also, 
removes  every  thing  from  our  view,  which  might 
recall  to  the  imagination  the  past  sorrows  of  the 
mind.  Those  little  troubles  too,  which  arise  from 
domestick  concerns,  and  which  often  solicit  too  much 
attention  from  hypochondriacks,  are  thus  far  removed 
from  their  sight. 

Finally,  that  lazy  disposition  in  which  hypochon- 
driacks indulge  at  home,  is  necessarily  banished  in 
travelling.  Inactivity  and  gloominess  of  mind  con- 
stitute the  greatest  part  of  this  disease:  whatever 
therefore  engages  the  attention,  would,  it  is  evi- 
dent,  be  very  useful;  and  all  exertions  of  the  mind, 


171 

although  forced  and  irksome  at  first,  occupy  its  at- 
tcntion,  and  serve  to  introduce  a  new  train  of  ideas. 

By  these  means  the  mind  is  gradually  restored  to 
its  wonted  cheerfulness,  the  intestines  take  on  their 
former  healthy  action^^,  and  each  reciprocally  imparts 
its  proper  vigour. 

*3  The  new  and  healthy  change  produced  in  the  morbid 
$tate  of  the  stomach  and  intestines,  which  occurs  in  the  dis- 
tressing disease  of  hypochondria,  is  undoubtedly  one  of  the 
most  efficient  and  potent  effects  of  travelling,  as  a  remedy  for 
this  complaint.  In  hypochondria.  Dr.  Gregory  has  pretermit- 
ted any  mention  of  a  sea-voyage,  and  wisely  indeed  has  he 
done  so.  I  have  heard  of  this  means  of  changing  place  and 
scene,  recommended  in  this  complaint,  than  which  no  advice 
could  be  more  irrational  and  disastrous.  It  is  somewhat  re- 
markable that  an  exercise  so  efficacious  as  that  derived  from 
a  sea-voyage,  in  many  other  complaints,  should  not  prove 
equally  beneficial  in  all  where  a  change  of  place  is  proper. 
Put  it  can  only  be  attributed  to  the  mental  uneasiness  I  have 
before  mentioned  (note  1 5),  produced  by  the  tumultuous  vexa- 
tions of  a  sea  life,  combined  with  the  want  of  other  comforts, 
as  cleanliness  of  person,  and  changes  of  dress,  which  are  the 
inevitable  concommitants  of  a  voyage,  particularly  of  a  long 
one.  A  change  of  dress  may  seem  a  matter  of  trivial  impor- 
tance; but  in  hypochondria  it  is  fur  from  being  so;  and  I 
well  know  from  actual  observation  that  this  disease^  which 


172 

as  I  shall  presently  say,  is  common  on  ship-board,  is  al- 
ways benefited  for  a  time,  by  a  change  of  dress.  This  disorder 
is  generated  by  the  monotony  of  a  sea  life,  and  generally 
affects  landmen  and  those  whose  habitual  occupations  of 
reading  or  amusement  on  shore,  are  interrupted  or  entirely 
prevented,  by  the  noisy  din  of  a  ship.  I  never  failed  to  ob- 
serve such  persons  better  after  muster  on  a  Sunday  morning, 
when  the  regulations  of  the  ship  compelled  every  one  on 
board  to  pass  inspection,  in  a  clean  and  fresh  attire.  But  a 
sea-voyage,  if  it  exceeds  a  day  or  two,  must  be  injurious  to 
hypochondriacks  for  the  reasons  I  have  mentioned.  As  th©; 
effect  of  travelling  on  the  bowels,  in  producing  a  new  and 
healthy  action  in  them,  has  just  been  mentioned,  it  may  here 
not  be  amiss  to  take  notice  of  some  of  those  affections  of  them, 
which  are  generated  by  particular  climates,  and  which  con- 
sequently we  may  reasonably  hope  to  cure,  by  flying  from  the 
place  where  they  received  existence. 

In  all  cases  of  disorder  of  the  intestines  depending  on  an 
undue  secretion  of  bile,  or  on  a  deficiency  of  this  secretion,  or 
an  unhealthy  state  of  il,  a  change  of  climate  by  means  of  a 
sea-voyage,  may  undoubtedly  be  expected  to  do  good.  "  Sea- 
sickness, and  a  sea-voyage,"  says  an  able  writer,  "  contribute 
very  much  to  restore  the  secretion  of  healthy  bile,  so  neces- 
sary to  the  welfare  of  the  animal  economy;  and  symptoms  of 
dyspepsia  and  diminished  secretion,  which  are  now  rendered 
more  conspicuous  among  females  from  their  sedentary  life, 
are  most  effectually  removed  by  the  means  already  suggest- 


173 

cd.***  It  is  however,  only  in  cases  where  these  affections,  as 
just  specified,  are  unconnected  with  any  mental  uneasiness 
such  as  occurs  in  hypochondria,  that  any  reasonable  depen- 
dance  can  be  placed  on  a  sea-voyage.  I  am  the  more  inclined 
to  this  opinion,  because  I  have  seen  decided  inconveniences, 
nay  bad  consequences,  arising  from  the  influence  of  a  sea  life 
on  hypochondriacks;  chiefly  because  it  aggravates  a  prominent 
symptom  of  this  disease,  viz.  costiveness. 

It  is  well  known  that  the  inhabitants  of  hot  countries,  are 
liable  to  many  diseases  which  have  their  sole  origin  in  the  de- 
rangement of  the  functions  of  the  liver,  produced  by  the 
heat  of  the  air.  The  most  common  of  these,  are  the  complaints 
generated  by  the  increased  secretion  of  bile,  either  causing  a 
regurgitation  of  it  to  the  stomach,  or  an  excessive  determina- 
tion of  it  to  the  firimce  via.  Hence  obstinate  dysenteries  and 
diarrhoeas  arise,  which  becoming,  as  they  very  frequently  do, 
chronick — produce  a  state  of  general  ill  health,  and  a  perpe- 
tual want  of  tone  in  the  stomach  and  intestines.  Such  a  situa- 
tion calls  for  a  change  of  climate.  By  means  of  this,  the  su- 
perabundant secretion  of  the  bile  is  reduced  to  the  healthy 
and  requisite  portion,  its  activity  on  the  alimentary  system 
consequently  very  much  lessened,  and  the  wonted  vigour 
of  the  stomach  reproduced.  With  the  healthiness  of  this 
organ,  the  intestines  receive  a  simultaneous  invigoration,  and 
the  evils  arising  from  the  disturbed  functions  of  both,  are 
speedily  and  effectually  banished  from  the  system.  The  dis- 
orders above  enumerated,  as  they  are  engendered  by  a  warm 

*  Suund«r3  «n  the  Liver,  duodec.  p.  148. 


174 

climate,  require  a  change  to  a  colder  region;  and  this  change 
effected  by  means  of  a  sea-voyage,  effectually  restores  the 
constitution  to  health  and  perhaps  to  vigour — provided  indeed 
the  hot  climate  had  not  made  such  pernicious  inroads  on  the 
system,  as  to  leave  the  liver  and  abdominal  vicera  in  a  radi- 
cally unsound  condition.  The  practice  of  seeking  relief  for 
violent  affections  of  the  vicera  of  the  abdomen,  produced  by 
the  vices  of  particular  climes,  is  of  very  old  date;  hence  we 
are  told  that  the  ancient  Carribean  Indians,  who  were  subject 
to  palsy  in  consequence  of  the  violent  convulsive  cholicks 
common  to  all  the  natives  of  the  torrid  zone,  had  themselves 
conveyed  to  countries  colder  than  their  own,  when  they  could 
not  resort  to  the  hot  baths  in  the  northern  parts  of  Jamaica; 
and  this  change  of  climate  was  always  followed  by  the  most 
beneficial  effects.*  The  present  professor  of  the  practice  of 
physick  in  this  university,  says  in  his  lectures,  that  he  has 
known  diarrhoeas  of  the  West  Indies  cured  by  the  patient^s 
coming  to  the  United  States. 

Besides  the  use  of  a  change  of  climate  in  the  disorders  of 
the  bowels,  produced  by  an  intensely  warm  climate:  we  may 
safely  recommend  such  change  in  the  obstinate  affections  to 
which  they  are  liable  in  our  own  country.  On  the  authority 
of  the  professor  just  mentioned,  I  may  state,  that  obstinate 
chronick  diarrhoeas  contracted  in  the  United  States,  have 
been  perfectly  cured  by  a  voyage  to  the  West  Indies. 

In 

*  Neale  on  Consumption,  p.  205, 


175 

In  cholera  infantum  we  know  it  to  be  the  common  practice 
of  physicians,  to  send  the  little  patients  into  the  country, 
and  this  is  not  unfrequently  done,  with  scarcely  a  ray  of  hope 
either  in  the  minds  of  the  parent  or  physician,  that  a  recovery 
will  be  the  consequence;  and  yet  a  few  weeks,  and  not  unfre- 
quently «  few  days  only,  have  been  known  to  snatch  the  pa- 
tient from  the  jaws  of  death  as  it  were.  In  this  disease  the 
sea-air  seems  peculiarly  favourable.  In  proof  of  this,  profes- 
sor Barton  says  that  it  is  a  very  common  and  mortal  com- 
plaint, in  the  town  of  Dover,  in  Delaware;  while  in  the  town 
of  Lewis  in  the  same  state,  but  on  the  very  borders  of  it,  and 
exposed  to  the  constant  influence  of  sea-air, — it  is  altogether 
unknown.  AH  these  facts  prove,  that  a  change  of  climate  is 
highly  beneficial  in  the  disorders  of  the  bowels;  to  which  I 
may  add  that  I  have  seen  unequivocal  advantages  arising  from 
a  sea  voyage,  in  all  the  chronick  affections  of  the  intestines  to 
which  seamen  are  so  liable  from  the  frequent  changes  in  their 
diet. 


176 


SECTION  IV, 


Of  Gout. — Of  the  effects  of  a  cold  and  humid  climate  on 
arthritick  constitutions,  and  the  general  inefficacy  of  the 
remedies  used  in  this  disease. — The  advantage  of  a  change 
of  climate  over  all  other  remedies  in  this  complaint,  parti- 
cularly from  a  cold  to  a  warm  one,  deduced  from  the  effects 
of  travelling  and  warm  air,  in  promoting  a  free  and  healthy 
determination  of  the  fluids  to  the  skin,  especially  in  old 
persons. — Also  the  beneficial  effects  of  a  mild  climate  on  the 
disorders  of  the  stomach,  so  intimately  connected  and  al- 
most always  combined  with  gout. — Arguments  in  favour  of 
a  change  of  climate  in  gout,  inferred  from  a  consideration 
of  the  remote  causes  of  the  disease.— Of  its  effects  in  avert- 
ing the  ill  consequences  of  repressed  gout,  which  generally 
succeed  the  use  of  other  remedies. 

A  FEW  observations  will  be  made  on  the  subject 
of  gout,  not  only  because  we  are  of  opinion  that  this 
disease  is  to  be  ascribed  to  the  effects  of  climate,  nor 
because  we  expect  that  a  change  of  climate  alone, 
without  the  use  of  other  remedies,  will  perform  a 
perfect  cure:  but,  on  account  of  the  variety  of  rea- 
sons which  incline  us  to  the  opinion,  that  our  cold, 
humid  and  variable  climate  is  extremely  hurtful  to 
gouty  persons,  and,  on  the  contrary,  that  warmer 


177 

countries  would  often  be  of  the  greatest  service  to 
them.  All  physicians  confess  that  but  a  small  num- 
ber of  remedies  are  truly  useful  in  this  disease; 
scarcely  any  that  can  radically  extirpate  it,  and  few 
that  can  assuage  the  agony  of  its  miserable  victims. 
Of  those  too,  which  hold  forth  the  prospect  of  re- 
lieving  pain  or  curing  the  disease,  some  become  so 
unpleasant  to  the  patients,  that  they  are  soon  rejected. 
Few  men  are  endowed  with  sufficient  fortitude  to  be 
willing  to  persist  for  any  length  of  time,  in  the  use 
of  disagreeable  medicines,  especially  if  they  be  not 
administered  during  the  actual  existence  of  the  vio- 
lent paroxysms,  but  only  given  during  the  intervals 
of  the  disease,  when  the  patient  experiences  neither 
inconveniences,  nor  pains,  nor  sickness.  All  physi- 
cians agree,  that  frequent  and  powerful  exercise  and 
slender  diet,  are  the  only  remedies  by  which  the 
cure  of  gout  can  be  safely  looked  for.  But  the  sick 
universally  reprobate  remedies  of  this  nature;  nor 
can  they  so  far  overcome  the  force  of  habit,  as  to 
consent  to  be  cured  of  their  disorder  on  such  condi- 
tions. But  the  disease  evidently  deprives  many  per- 
sons of  the  use  of  the  limbs,  so  that  exercise  is  ren- 
dered impossible;  while  others,  on  account  of  their 
debilitated  state,  or  from  other  causes,  absolutely 

Z 


178 

stand  in  need  of  a  generous  diet.  A  pleasant,  effica- 
cious and  safe  remedy  for  this  disease,  is  therefore 
an  important  desideratum;  and  I  entertain  the  greatest 
hopes  that  a  warm  climate  is  gifted  with  these  ad- 
vantages. There  are  some  remedies  indeed  which 
mitigate,  for  a  short  time,  the  excruciating  pains  of 
gout,  and  others  which  seem  to  drive  the  disease 
from  the  whole  system;  but  they  are  often  observed 
to  bring  upon  the  wretched  patients,  new  and  more 
distressing  disorders,  or  even  death  itself.  Of  this 
kind  are  the  various  remedies  applied  to  the  pained 
parts,  especially  discutients,  or  cold,  or  such  as  are 
composed  of  spirit  of  wine  and  the  like;  certain  me- 
dicines also,  taken  into  the  stomach,  and  particularly 
aromaticks  and  bitters,  such  as  compose  the  Portland 
powder.  Since  therefore,  gout  not  unfrequently  acts 
in  some  way  as  a  remedy  for  other  and  more  afflict- 
ing diseases,  it  surely  ought  not  to  be  cured,  with- 
out we  could  at  the  same  time  prevent  the  evils 
which  usually  arise  from  repressed  gout:  and  this 
too  is  best  effected  by  a  change  of  climate. 

It  is  not  my  intention  to  treat  fully  and  particu- 
larly of  gout:  it  will  be  sufficient  to  show  the  useful- 
ness of  a  change  of  climate,  by  noticing  some  of  the 


17^ 

remote  causes  of  the  disease,  and  from  our  experi- 
ence of  those  things  which  are  beneficial  or  hurtful. 
I  am  not  able  to  draw  any  conclusion  of  this  nature 
from  the  proximate  cause  of  the  disorder,  since  it  is 
so  very  obscure.  Some  of  the  remote  causes  indeed, 
are  scarcely  better  understood,  and  particularly  the 
predisposition,  strictly  called,  or  the  germ  of  the  dis- 
ease. Something  of  this  kind  exists  we  well  know; 
for  the  most  of  the  remote  causes,  either  predispos- 
ing or  occasional,  produce  gout  only  in  some  persons, 
while  in  others  they  have  not  the  effect  of  generating 
any  disease  at  all,  or  one  of  an  entirely  different  na- 
ture.  But  the  nature  of  that  predisposition  or  the 
seeds  of  the  disease  which  are  transmitted  from  pa- 
rents to  their  offspring,  remains  as  yet  in  obscurity. 
We  must  seek  in  other  sources  of  reasoning  then, 
further  exposition.  The  other  predisposing  causes 
are,  particularly,  advanced  age,  too  full  a  habit  of 
body,  with  corpulency,  plethora,  rich  living,  drunk- 
enness, premature  and  immoderate  venery,  and  above 
all,  an  indolent  and  sedentary  life.  With  respect  to 
the  occasional  or  exciting  causes,  there  is  no  occa- 
sion to  say  much.  I  can  hardly  believe  that  gout  is 
ever  produced  by  any  sudden  or  violent  cause,  un- 
less a  strong  disposition  to  it  had  previously  existed 


180 

in  the  system;  and,  when  that  disposition  does  exists 
the  disease  generally  recurs  periodically  without  any 
evident  exciting  cause.  Sometimes  indeed  a  pa- 
roxysm is  brought  on  by  powerful  affections  of  the 
mind,  (though  not  unfrequently  it  is  banished  by  the 
same);  sometimes  the  infliction  of  external  violence, 
particularly  on  the  lower  limbs,  a  sprain,  or  fatigue; 
occasionally,  an  omission  of  an  accustomed  exercise, 
or  a  suppression  of  a  customary  evacuation;  often  im- 
proper food,  gluttony,  a  surfeit,  and  whatever  pro- 
duces indigestion  and  acidity  in  the  stomach.  For  it 
is  well  known  that  affections  of  this  kind,  are  almost 
always  the  precursors  of  a  paroxysm  of  gout. 

But  besides  this,  the  exciting  causes,  and  perhaps 
also  the  predisposing,  often  arise  from  the  state  of 
the  air.  Regular  gout,  which,  when  it  has  begun, 
generally  recurs  about  the  same  time  of  the  year: 
afflicts  the  patient  first  in  the  spring;  for  the  most 
part  in  the  end  of  January  or  beginning  of  February; 
never  in  summer  time,  unless  from  some  sudden 
and  violent  exciting  cause.  After  the  disease  has  ad- 
vanced, when  the  patient  suflTcrs  two  paroxysms  dur- 
ing the  year,  one  happens  in  the  spring  and  the  other 
in  the  autumn:  but  in  summer  the  patient  is  entirely 


181 

exempt  from  the  complaint.  Finally,  in  those  cases 
when  the  patient  is  so  very  severely  afflicted,  as  to 
lose  the  use  of  his  limbs,  and  is  confined  to  bed  for 
a  considerable  portion  of  the  year,  he  derives  the 
greatest  relief  from  the  summer  season.  Those  ex- 
cruciating pains  which  medicine  can  scarcely  touch, 
are  always  greatly  relieved  by  the  provision  of  nature, 
and  generally  cease  altogether  during  these  three  or 
four  months  of  the  year.  Reasoning  from  this  fact,  a 
change  of  climate  promises  the  highest  advantages 
in  this  disease. 

Cold  air  is  doubtless  injurious  to  gouty  persons; 
for  they  carefully  cover  the  parts  particularly  affected 
with  the  disease,  and  derive  some  relief  from  this 
practice.  The  most  judicious  physicians  indeed  do 
not  permit  any  other  remedy  to  be  applied  to  the 
pained  limb,  than  woollen  cloth,  or  something  of  a 
similar  kind.  It  is  agreed  too  that  sudden  applica- 
tion of  cold  to  the  body,  not  unfrequently  brings  on 
a  gouty  paroxysm.  And  gouty  persons  frequently 
feel  slight  arthritick  pains  when  any  degree  of  cold 
is  applied  to  the  feet.  Physicians  well  know  also, 
that  a  checking  of  the  customary  sweat  or  perspira- 
tion of  the  feet,  is  often  the  forerunner  of  a  gouty  pa- 


182 

roxysm.  Slight  paroxysms  too,  which  produce  seve. 
rer  ones,  are  dissipated  by  gentle  bathing  of  the  feet 
or  sometimes  of  the  whole  body.  Hence  therefore, 
it  is  very  probable  that  suppressed  perspiration  is 
injurious  to  the  gouty  patients,  while  a  free  discharge 
by  the  skin  is  beneficial.  In  spring  and  in  autumn 
when  the  weather  is  very  variable,  the  disease  is 
greatly  aggravatedi  and  in  summer,  as  we  have  be- 
fore remarked,  it  ceases.  To  avoid  therefore  the  re- 
mote causes,  either  predisposing  or  occasional,  aris- 
ing from  the  air,  a  change  of  climate  is  strenuously 
to  be  recommended.  We  shall  now  notice  in  what 
way  a  favourable  climate  promises  to  overcome  the 
other  remote  causes. 

Disorders  of  the  stomach  almost  always  precede  a 
paroxysm  of  gout,  and  indeed  afflict  most  gouty 
persons,  and  constitute  a  great  part  of  the  disease. 
When  speaking  of  hypochondria  we  remarked  that 
warm  climates  are  not  much  disposed  to  produce 
these  diseases,  and  indeed  with  us  they  occur  rarely 
in  the  summer  season.  To  whatever  causes  therefore 
that  relief  of  the  diseases  of  the  stomach  which  arises 
from  a  mild  atmosphere,  is  to  be  ascribed;  whether 
to  its  direct  action  on  the  nervous  system  or  to  its 


183 

effects  in  promoting  and  distributing  the  fluids — it  is 
evident  that  a  change  of  climate  is  of  the  greatest 
advantage  in  those  affections — and  as  they  are  cured 
or  relieved,  it  is  reasonable  to  expect,  that  gout 
would  derive  infinite  benefit  from  the  same  sources. 

Gout,  as  we  have  before  observed,  generally  at- 
tacks those  who  have  passed  the  prime  of  life,  that 
is,  who  have  reached  the  thirtieth  or  thirty- fifth  year 
of  age.  In  infancy  it  is  almost  altogether  unknown, 
and  in  boyhood  is  exceedingly  rare:  But  in  more  ad- 
vanced age  the  perspiration  is  sensibly  diminished; 
for  many  minute  vessels  and  cutaneous  pores,  are 
contracted  in  process  of  time,  and  coalesce.  Old 
men  generally  neglect  to  take  their  accustomed  and 
necessary  exercise,  for  the  pristine  activity  of  miriU 
and  body  are  then  wanting;  and  they  are  often  engag- 
ed in  sedentary  employments.  In  such  men  therefore, 
travelling  into  warm  countries,  if  I  am  not  mistaken, 
would  prove  very  successful,  and  restore  the  distri- 
bution to  the  surface  and  the  excretion  by  the  skin, 
and  perhaps  might  in  this  way  relieve  this  disease. 

Gout  generally  attacks  those  who  indulge  in  high 
living,  and  are  given  to  the  excessive  Ose  of  wine 


184 

and  other  spiritous  liquors.  To  these  therefore, 
above  all  other  men,  we  believe  that  the  freest  per- 
spiration  by  the  skin  is  necessary;  for  a  certain  equi- 
librium between  what  is  taken  in  and  passed  out  of 
the  system,  is  required  for  health.  Now  this  balance 
is  evidently  disturbed,  if  any  one  uses  too  full  a  diet, 
and  leads  an  indolent  and  sedentary  life.  Experience 
satisfactorily  shows,  that  various  diseases  are  pro- 
duced by  this  cause,  and  especially  gout.  Men  who 
use  a  temperate  and  light  diet,  although  they  may 
lead  an  inactive  life,  are  rarely  attacked  by  gout:  and 
those  who  use  powerful  and  frequent  exercise,  espe- 
cially  those  who  get  an  appetite  by  hard  and  con- 
tinual labour,  although  they  daily  consume  a  great 
quantity  of  gross  food,  nay,  and  indulge  in  spiritous 
liquors — are  rarely  troubled  with  this  complaint. 
There  are  some  examples  even,  of  men  having  suf- 
fered hereditary  gout  (which  is  generally  esteemed 
the  worst,  and  the  most  difficult  of  cure)  for  many 
years,  being  reduced  to  poverty,  and  obliged  to  seek 
a  livelihood  by  hard  labour — have  been  entirely 
cured.  Examples  of  this  kind  very  clearly  show  of 
how  much  importance  it  is  for  relieving  or  curing 
this  disease,  that  the  freest  determination  of  the  fluids 
to  the  surface  of  the  body  should  be  promoted.  I 


185 

am  by  no  means  ignorant,  that  another  and  altogether 
different  reason  might  be  given  on  this  subject,  and 
attributed  to  the  benefit  received  by  exercise  and  its 
effects  on  the  solid  parts.  Exercise  without  doubt 
not  only  promotes  a  free  distribution  of  the  fluids, 
but  also  procures  strength  and  vigour  to  the  mus- 
cles and  the  general  constitution,  preserves  and  in- 
creases it.  I  will  not  contend  that  exercise  would 
not  in  this  way  be  beneficial  to  ttie  gouty,  especially 
to  those  already  broken  and  debilitated  by  the  dis- 
ease. 

But  there  are  arguments  arising  from  the  history 
of  the  disease,  and  from  analogy  of  those  things  that 
are  useful,  which  show  that  the  benefit  derived  from 
exercise  is  to  be  attributed  at  least  in  a  great  mea- 
sure, to  its  effects  in  promoting  a  due  distribution  of 
the  fluids.  From  what  has  been  said  above,  if  I  be 
not  mistaken,  it  plainly  appears — that  obstructed  per- 
spiration is  very  hurtful  to  the  gouty.  And  the  dif- 
ferent things  which  relieve  these  patients,  can  hardly 
act  in  any  other  way,  than  by  promoting  the  perspi- 
ration and  due  distribution  to  the  surface.  Of  this 
kind  are  plentiful  and  warm  clothing,  especially  to 
the  pained  parts,  from  which  almost  all  gouty  per- 

2  A 


186 

sons  experience  relief:  also  the  tepid  and  even  the 
hot  bath,  and  frequent  and  powerful  frictions,  from 
which  many  derive  the  greatest  assistance;  and  some, 
very  much  broken  by  the  disease,  have  recovered 
the  use  of  their  limbs  which  they  had  almost  lost. 
There  is  no  occasion  to  repeat  what  has  already  been 
said  respecting  the  benefit  accruing  in  this  dreadful 
disease,  from  the  summer  heat.  It  may  be  reason- 
ably collected  from  all  these  facts,  as  it  seems  to  me, 
that  a  free  perspiration  is  especially  necessary  in 
curing  this  disease;  and  we  have  before  proved,  that 
a  climate  moderately  warm,  eminently  effects  that 
purpose,  because  the  sick,  however  greatly  broken 
down  and  debilitated,  can  receive  the  advantage  of 
it  as  long  as  they  please  without  danger  or  detri- 
ment. I  would  therefore  recommend  a  change  of 
climate  to  the  gouty,  for  these  reasons  particularly: 
that  all  the  injury  which  arises  from  our  winter,  may 
be  avoided,  and  the  advantage,  whatever  it  may  be, 
which  the  summer  season  affords,  might  be  continu- 
ed, and  so  that  the  perspiration  and  due  determina- 
tion of  the  fluids  to  the  surface,  might  be  promoted; 
or  if  it  should  have  been  checked,  so  that  it  might 
be  restored. 


187 

Another  argument  may  be  added  to  these, 
and  though  it  is  an  uncertain  one,  and  does  not 
appear  at  all  accurate,  yet  I  do  not  think  on  that  ac- 
count that  it  is  irrelevant.  We  have  before  observed 
that  the  seeds  of  gout  exist  in  the  constitution  of 
some  persons;  but  since  the  nature  of  this  predispo- 
sition as  yet  is  concealed,  it  can  hardly  be  expected 
that  a  powerful  remedy  will  be  found  by  which  it 
can  be  corrected  or  extirpated.  **  For  since  in  this 
disease  (as  Sydenham  has  judiciously  mentioned)  its 
cause  exerts  such  an  influence  over  the  constitution 
as  to  render  its  very  nature,  new  as  it  were,  no  ra- 
tional being  could  suppose  that  a  slight  or  temporary 
alteration  either  produced  by  medicines,  or  by  a  par- 
ticular diet,  could  produce  a  radical  cure;  but  the 
general  habit  of  body  must  be  brought  into  a  different 
condition,  and  the  entire  man  as  it  were  subsequently 
re-organized."  But  if  the  condition  of  the  system  is 
entirely  or  almost  entirely  changed,  it  is  not  impro- 
bable that  the  peculiar  disposition  would  be  altered 
or  corrected.  It  is  known,  that  certain  changes  which 
the  constitution  undergoes,  bring  that  disposition 
into  view:  for  in  the  state  of  infancy  or  boyhood,  it 
rarely  shows  itself;  while  the  disease  generally  makes 
its  attacks  in  manhood.  The  constitution  therefore 


188 

undergoes  in  that  age,  certain  changes  favourable  to 
this  disposition.  Therefore  we  might  hope  that  other 
changes  would  be  able  to  expel  or  correct  a  gouty 
disposition.  Now  the  constitution  of  the  system  is 
most  altered  by  a  change  of  climate:  and  experience 
plainly  shows  that  travelling  into  warm  countries 
would  be  not  only  safe  in  this  disease,  but  even  very 
useful  and  pleasant  to  the  patients. 

There  is  a  very  remarkable  case,  and  very  appo- 
site  to  these  observations,  which  the  celebrated  Van 
Swieten  has  mentioned  in  his  Commentaries,  of  a 
man  who  in  the  thirty-first  year  of  his  age,  laboured 
severely  under  gout,  and  lost  almost  entirely  the  use 
of  his  hands  and  feet.  In  this  condition  he  took  a  voy- 
age to  the  East  Indies,  with  a  view  to  derive  benefit 
from  the  climate.  He  returned  to  his  native  country 
after  a  lapse  of  three  years,  and  in  consequence  of 
the  heat  of  the  air,  without  the  use  of  any  other  re- 
medies, he  lived  healthy  and  perfectly  free  from  gout. 

A  similar  case  is  related  by  the  illustrious  Haller, 
of  Lord  de  Poihcy,  who  when  an  old  man,  and  al- 
ready  severely  afflicted  with  gout,  went  to  the  warm 
islands  of  America,  where  he  lived  many  years  with 


189 

the  effect  of  being  freed  from  gout  and  all  the  other 
evils  of  old  age,  and  recovered  his  former  health. 

A  case  similar  to  this  I  received  from  a  very  learn- 
ed physician,  who  often  saw  the  patient  while  he 
lived  abroad.  A  nobleman  laboured  for  many  years 
under  gout,  until  at  length  the  disease  so  much  in- 
creased, that  he  was  grievously  afflicted  the  greatest 
part  of  the  year.  The  patient  had  used  many  reme- 
dies without  effect.  He  lived  for  a  long  time  on  a 
diet  of  milk  alone.  The  disease  however  daily  grew 
worse.  He  made  a  journey  into  Italy,  where  in  a  short 
time  he  had  a  most  severe  paroxysm,  (though  of 
short  duration).  Afterwards,  however,  he  lived  free 
from  the  disease,  and  still  lives  after  many  years.  It 
must  be  observed,  that  this  patient  remained  only  two 
years  in  Italy,  and  while  he  staid  there  he  indulged 
in  a  somewhat  more  generous  diet  than  before. 


190 


SECTION  V. 


Of  invigorating  old  age. — The  signs  and  effects  of  declining 
life  in  old  persons,  and  the  particular  consequences  of  the 
depreciated  functions  of  the  system. — Reasons  why  a  change 
of  climate  may  be  expected  to  relieve  them,  and  produce  a 
general  invigoration  of  the  fading  body. — Of  the  injurious 
effect  of  a  cold  and  humid  climate  upon  old  people,  and  the 
advantages  to  be  derived  from  travelling  to  warm  countries. 

I  MAY  advance  in  this  place,  a  few  observations 
respecting  the  relief  of  old  age,  and  protracting  hu- 
man life  beyond  its  ordinary  limits,  by  means  of  the 
influence  of  a  change  of  climate.  They  will  neither 
be  useless  nor  foreign  to  the  subject  of  this  discourse. 
Some  physicians  of  eminence  suppose,  that  old  age 
itself  is  a  true  disease,  which  can  derive  relief  from 
our  art.  Others  indeed,  contend  that  old  age  is  a 
natural  and  inevitable  condition  of  life,  and  that  there- 
fore it  can  neither, be  relieved  nor  rendered  a  disease, 
by  means  of  human  art.  It  is  not  my  intention  to 
enter  into  a  discussion  of  this  question,  for  it  would 
be  both  useless  and  impertinent  to  my  subject,  to 


I 


191 

do  so.  Whether  it  be  a  disease,  or  a  natural  state,  it 
is  very  certain  that  old  age  brings  with  it  many  in- 
conveniences, renders  the  system  liable  to  many  dis- 
orders, evidently  diminishes  all  the  natural  powers 
both  of  mind  and  body,  and  sooner  or  later  brings  on 
death  itself.  This  state  therefore,  stands  in  great 
need  of  all  the  precautions  and  assistance  that  medi- 
cine can  afford.  For  it  is  the  province  of  physicians 
not  only  to  cure  diseases,  but  to  maintain  health, 
and  as  far  as  is  allowed  to  mortals,  to  preserve  and 
prolong  life.  The  science  of  medicine  would  conse- 
quently be  very  imperfect,  if  it  could  not  supply  any 
remedies  calculated  to  accomplish  this  end.  Espe- 
cially since  there  are  some  evil  disposed  persons, 
who  contend  that  our  healing  art,  sometimes  shortens 
the  span  of  human  life. 

I  am  not  indeed  acquainted  with  any  remedies, 
which  are  endued  with  the  power  of  making  us 
young  again:  yet  I  do  not  at  all  doubt,  that  reme- 
dies might  be  found  sufficiently  efficacious  to  be  able 
to  ward  off  immediate  old  age,  and  to  prolong  life 
for  some  years  beyond  its  natural  bounds,  as  well  as 
to  keep  the  health  and  powers  of  the  system  but 
little  impaired.  But  such  a  virtue  cannot  be  expect- 


192 

cd  from  the  use  of  medicine  for  a  short  time.  To 
achieve  such  an  effect  on  the  system,  it  is  not  only 
necessary  that  an  efficacious  remedy  should  be  em- 
ployed, but  that  it  should  be  long  continued,  and 
that  the  general  constitution  should  undergo  a  proper 
and  almost  entire  revolution. 

In  many  cases,  where  the  general  system  is  con- 
taminated by  some  vice,  and  is  threatened  with  some 
serious  danger,  a  change  of  the  whole  habit  of  body, 
often  succeeds  very  happily.  It  is  very  well  known  to 
every  one,  than  an  intemperate  or  improper  mode  of 
life,  often  brings  on  a  protracted  state  of  ill  health, 
and  premature  old  age.  Reason  and  experience  there- 
fore both  prove,  that  a  proper  kind  of  life  can  pre- 
vent those  inconveniences,  maintain  health,  and  re- 
tard the  approach  of  old  age,  as  well  as  protract 
life.  How  much  a  proper  change  in  the  mode  of  life 
conduces  to  this  effect,  Cornaro  has  very  clearly  evi- 
denced. After  having  past  his  fortieth  year,  he  felt 
that  his  constitution  was  in  a  manner  broken  down, 
and  debilitated  by  his  intemperate  kind  of  life:  he 
took  leave  of  his  former  habits,  led  a  sober  and  tem- 
perate life,  recovered  his  pristine  vigour,  and  com- 


193 

pleted  his  hundredth  year,  without  the  health  of  his 
body  or  the  faculties  of  his  mind  being  impaired. 

We  have  before  said  that  a  change  of  climate  pro- 
duces powerful  effects  on  the  human  body:  and 
if  a  man  should  live  sufficiently  long  under  another 
sun,  it  is  not  improbable  that  his  constitution  would 
be  entirely  changed.  Various  are  the  arguments 
which  influence  me  in  adopting  the  opinion,  that  a 
change  to  a  warm  climate  would  be  very  useful  to 
most  old  persons.  No  rational  creature  can  suppose 
that  a  change  of  climate,  or  any  other  remedy,  will 
banish  old  age  forever,  or  that  it  could  prolong  hu- 
man life  to  eternity,  or  even  for  a  long  series  of 
years.  I  shall  not  promise  so  miraculous  a  remedy. 
But  there  are  many  who  find  their  health  broken, 
and  their  powers  impaired,  and  who  feel  death  close 
upon  them,  who  would  seize  with  the  greatest  eager- 
ness a  remedy,  by  which  life  could  be  extended  only 
for  a  few  years,  and  which  might  in  some  measure 
regenerate  the  languid  and  impaired  powers  of  the 
system. 

In  our  opinion,  there  are  some  obstacles  to  the 
long  continuance  of  human  life,  in  every  part  of  the 
2B 


194 

globe;  but  if  there  be  any  difference,  they  are  greater 
in  our  northern  countries  than  in  the  regions  of  the 
torrid  zone.  But  we  have  before  remarked,  that  a 
warm  climate  produces  much  more  powerful  effects 
upon  travellers,  than  upon  men  who  live  continually 
under  its  influence.  If  any  one  is  continually  accus- 
tomed to  the  useful  remedy  it  affords,  he  evidently 
loses  whatever  degree  of  benefit  might  be  expected 
from  its  operation.  Nay,  I  could  easily  believe,  that 
the  immoderate  use  of  this  remedy,  would  not  only 
do  no  good,  but  would,  in  many  cases,  prove  very 
injurious.  If  any  one  of  our  inhabitants,  healthy 
and  robust,  and  in  the  bloom  of  life,  was  to  seek 
more  fervid  climates,  where  he  might  live,  his  life 
would  not  only  not  be  prolonged,  but  perhaps  would 
be  curtailed,  and  he  would  prepare  for  himself  a  pre- 
mature  old  age — melancholy  examples  of  this  kind, 
are  daily  presented  to  our  view.  We  should  sedu- 
lously attend,  respecting  this  remedy,  to  what  Celsus 
formerly  judiciously  admonished,  with  regard  to 
others;  namely,  that  we  should  take  care  lest  in  our 
efforts  to  preserve  health,  its  real  interests  were  not 
destroyed  by  injurious  cautions. 

I  shall  endeavour  therefore  to  show,  what  changes 


195 

occur  in  old  age,  the  way  in  which  our  climate  is 
pernicious  to  old  persons,  and  the  reason  why  tra- 
velling into  warm  countries  should  be  recommended 
to  them.  I  do  not  design  to  treat  here  of  all  the  evils 
particularly,  to  which  old  age,  in  these  northern 
countries,  is  subject,  and  which  might  be  prevented, 
relieved  or  cured,  by  a  change  of  climate.  1  intend 
to  make  some  remarks  only  upon  those  changes  and 
differences  that  are  natural  to  old  age,  and  which 
attack  sooner  or  later  the  healthiest  and  most  vigor- 
ous, break  down  and  waste  away  the  constitution, 
and  finally  sweep  them  from  the  busy  scenes  of  life. 

In  the  progress  of  years,  the  human  body  suffers 
various  alterations  which  injure  all  the  powers  and 
natural  functions  of  the  system;  consequently  many 
inconveniences  are  brought  upon  the  aged.  These 
changes  affect  the  whole  system,  and  undermine  and 
weaken  it  in  every  part;  they  especially  affect  the 
nervous  system,  blunt  the  understanding,  diminish 
the  strength  and  energy  of  the  mind  and  body,  ren- 
der the  solid  parts  stiff  and  hard,  and  greatly  impede 
the  motion  and  distribution  of  the  fluids.  All  these 
evils  evidently  increase  by  degrees;  yet  it  is  very 
difficult  to  explain  their  beginning  and  origin,  or  t© 


196 

detect  which  is  the  cause  of  the  others.  If  we  begin 
from  the  impeded  distribution  of  the  fluids,  a  ques- 
tion arises,  why  this  is  disturbed,  if  the  solid  parts 
and  the  moving  powers  remain  sound,  natural  and 
entire?  Or,  if  we  begin  from  the  induration  and 
atony  of  solid  parts,  and  especially  of  the  arteries  and 
muscles,  it  will  be  difficult  to  assign  a  reason  why 
these  have  become  indurated,  and  have  lost  their 
powers,  if  the  distribution  of  the  fluids  is  properly 
promoted,  and  the  nervous  energy  not  diminished. 
Finally,  if  we  begin  from  a  defiiciency  of  the  nervous 
power  itself,  (whence  doubtless  all  the  other  evils 
spontaneously  flow),  we  should  explain,  why  this  is 
deficient,  if  the  motion  of  the  blood  and  the  rest  of 
the  functions  of  the  animal  machine  are  performed 
properly  and  in  the  usual  manner.  For  the  action  of 
the  heart  and  the  nervous  energy  reciprocally  sup- 
port each  other.  It  must  therefore  be  acknowledged, 
that  the  human  body  is  a  circle,  the  beginning  and 
the  end  of  which  are  as  yet  concealed,  and  perhaps  for 
a  long  time  will  continue  unexplored.  All  things  that 
are  necessary  to  life  and  for  the  health  and  increase 
of  the  body,  are  not  accurately  understood;  it  can 
hardly  be  expected  therefore  that  the  cause  of  any 
default  in  them,  should  be  nicely  comprehended. 


197 

Yet  we  do  know  many  things  that  are  necessary  to 
life  and  growth,  and  which  support  the  strength  and 
hcahh  of  the  body;  we  are  acquainted  too  with  rriany 
which  are  inimical  to  all  these,  which  diminish  the 
powers,  destroy  the  health,  waste  the  body,  and 
pave  the  way  for  death  itself.  We  know  moreover 
that  all  these  increase  each  other,  so  that  the  consti. 
tution  is  daily  running  into  a  worse  condition. 

But  all  the  changes  which  arise  from  old  age,  may 
be  reduced  to  three  heads;  to  impaired  nervous  en- 
ergy, and  induration  of  the  solid  parts,  and  an  ob- 
struction of  the  free  distribution  of  the  fluids.  Of 
each  of  these  effects  we  shall  now  proceed  to  treat 
more  particularly.  The  first  signs  which  generally 
accompany  and  denote  incipient  old  age,  are  observ- 
ed to  arise  from  impaired  nervous  power.  All  the 
senses  both  external  and  internal,  by  degrees  are 
rendered  more  obtuse.  Sight,  hearing,  smelling, 
taste,  are  sensibly  deficient;  hence  most  old  persons 
dislike  light  and  unadulterated  food,  which  they  be- 
fore were  fond  of — and  crave  a  more  savoury,  salt 
and  high  seasoned  diet.  The  cheerfulness  of  youth 
gives  way  by  degrees  to  the  gravity  of  age.  The 
strength  and  activity  of  the  body,  are  also  sensibly 


198 

diminished;  hence  most  old  men  leave  off  all  the 
more   powerful  exercises,   and  very   willingly  ex- 
change the  toil  of  business  for  a  life  of  tranquillity 
and  ease.  Upon  still  more  advanced  age,  the  strength 
of  the  muscles  is  daily  more  and  more  diminished, 
until   at  length   confirmed   old  age  causes  a  loss 
of  almost  all  the  uses  of  the  limbs.  The  faculties  of 
the  mind  also  by  degrees  waste  away.  The  imagina- 
tion is  depressed,  and  memory  totters;  at  first  in- 
deed, recent  ideas  easily  escape  it,  although  old  ones 
which  it  formerly  imbibed  it  very  tenaciously  retains. 
But  afterwards  all  ideas,  both  old  and  recent,  are 
dropt   from   the  memory  altogether,    and  then  the 
judgment  is  destroyed. — The  solid  parts  of  the  body 
become  hard:  the  cellular  texture  is  not  only  harder 
so  as  to  resist  the  knife,  but  has  obtained  a  greater 
power  of  adhering.  Hence  the  skin,  which  in  youth 
was  soft,  smooth,  and  equal,  by  degrees  becomes 
hard,  and  rough.  The  numberless  invisible  pores 
are  contracted,  and  altogether  closed  up;  hence  per- 
spiration is  obstructed,  and  the  skin  acquires  a  pecu- 
liar dryness.    The  arteries  of  old  persons  become 
thicker,  more  rigid,  and  even  narrower,  and  many 
of  the  smaller  ones  are  gradually  closed  up.  The 
veins  also  acquire  a  greater  thickness  and  strength 


199 

than  in  youth,  but  never  in  the  same  proportion  as 
the  arteries.  Hence,  from  the  greater  resistance  and 
diminished  impetus,  (to  wit,  by  the  moving  powers 
being  now  impaired),  the  motion  of  the  blood  is 
slower;  so  that  the  veins  of  old  persons  become 
larger  and  not  unfrequenily  varicose.  From  this 
cause  also,  and  the  diminished  irritability  of  the 
heart,  (from  a  defect  of  nervous  energy),  the  pulses 
beat  more  slowly.  The  brain  itself,  the  nerves,  all 
the  viscera — become  indurated,  so  that  the  muscular 
fibres  often  become  almost  altogether  converted  into 
a  very  hard  tendinous  substance.  This  induration 
evidently  arises  from  a  deficiency  of  the  fluids, 
which  cannot  now,  as  formerly,  flow  through  the 
smallest  vessels,  by  this  time  contracted  and  closed. 
The  same  reason  might  chiefly  be  given,  for  the  de- 
bility of  the  muscles,  and  the  decrease  of  the  whole 
body,  which  are  observed  in  old  age:  For  however 
large,  corpulent  and  robust  bodies  may  be  in  the 
first  stage  of  old  age,  they  become  in  the  last,  in- 
active, and  ahogether  debilitated.  If  the  vessels 
which  used  to  carry  blood  to  any  part,  are  contract- 
ed, or  closed,  so  as  to  convey  no  blood,  or  but  an 
inconsiderable  quantity,  it  is  evident  that  such  part 
cannot  be  nourished  as  before;  it  is  not  surprising 


200      ' 

therefore,  that  it  pines  away,  and  loses  the  powers 
which  it  formerly  possessed.  Besides,  many  vessels, 
and  lacteal  glands  of  the  mesentery,  are  obliterated  in 
extreme  old  age;  and  thence  perhaps  it  is  probable  that 
a  much  less  quantity  of  nutriment  will  be  conveyed 
to  the  blood,  from  the  same  food. — With  regard  to 
the  obstructed  motion  and  distribution  of  the  blood, 
there  is  no  doubt.  A  defect  of  nervous  energy  in 
consequence  of  the  debility  of  the  moving  parts,  the 
greater  resistance  of  the  arteries,  and  from  the  con- 
striction or  choaking  of  innumerable  minute  vessels, 
and  cutaneous  pores, — it  is  evident  that  the  blood 
does  not  flow  freely  through  the  whole  body,  as  be- 
fore. All,  nearly,  of  the  minute  excretions,  and  some 
suppressed  ones,  the  dryness  and  fading  and  hard- 
ness of  the  body,  demonstrate  the  fact  beyond  the 
possibility  of  doubt.  The  perspiration  in  old  persons 
is  very  much  lessened,  and  often  almost  watery. 
Their  bowels   also   are  generally   observed  to  be 
slow  or  inactive.   Hence,   according  to  many  and 
very  celebrated  authors,  an  acrimony  of  the  fluids 
is  produced,  from  a  retention  of  those  parts  which 
ought  to  be  excreted  and  passed  out.  But  the  na- 
ture of  this  acrimony,  so  far  as  I  know,  is  not  ac- 
curately understood.    I  will   not  deny   that  many 


201 

disorders  happen  in  the  fluids  of  old  persons:  And 
from  the  deficiency  of  the  other  natural  powers, 
which  were  wont  to  prepare  properly  the  blood,  it  is 
not  improbable,  that  it  will  become  feeble  or  other- 
wise diseased.  Old  persons  are  sometimes  liable  to 
disease,  evidently  the  consequence  of  a  defect  in  the 
motion  of  the  blood,  namely,  necrosis,  or  gangrene, 
which  generally  attacks  first  the  feet,  afterwards  the 
legs,  and  induces  though  slow,  yet  certain  death. 

The  reason  therefore  is  plain,  why  our  cold,  moist, 
and  variable  climate  is  unfriendly  to  old  people.  In 
the  first  place  it  injures  the  nervous  system,  and 
diminishes  the  power  and  activity  both  of  body  and 
mind:  Hence  the  due  distribution  of  the  fluids  is 
impeded,  and  the  atony  and  hardness  of  the  solid 
parts  increased.  Moreover,  cold  and  moist  air  (as 
we  have  already  remarked)  obstructs,  directly  and 
immediately,  the  perspiration,  and  the  free  determi- 
nation to  the  surface.  Cold  also  causes  an  induration 
and  stiffness  of  the  external  skin,  and  the  other  solid 
parts.  But  all  these  things  occur  naturally  to  old 
persons,  and  when  they  do  happen  (as  wc  have  re- 
marked above)  they  increase  each  other. 

2C 


202 

From  the  history  of  old  age  it  may  be  gathered, 
that  the  evils  which  occur  to  it,  especially  require 
three  things:  namely,  to  sustain  and  nourish  the  ner- 
vous  power,  or,  if  it  is  already  depreciated,  to  re- 
store it:  to  prevent  or  remove  an  excessive  hardness 
of  the  solid  parts,  and  promote  the  due  distribution 
of  the  blood.  If  all  these  things  can  be  exactly  ac- 
complished as  we  would  desire,  there  is  no  doubt 
but  that  the  former  vigour  and  complete  youth  would 
be  restored.  But  if  they  are  only  partially  achieved, 
the  energy  and  power  will  be  renovated  in  some 
measure,  delay  the  immediate  approach  of  old  age, 
and  perhaps  prolong  life  for  many  years.  I  do  not 
know  any  remedies  which  answer  these  intentions 
better  than  a  change  of  climate,  by  travelling  in 
warm  countries. 

Nor  is  it  a  matter  of  small  importance  that  this 
remedy  is  both  safe  and  pleasant  at  the  same  .time, 
for  all  the  evils  of  old  age.  We  plainly  see  that  all 
these  disorders  increase  each  other;  yet  we  never 
know  which  one  is  the  cause  of  the  rest.  It  is  of 
the  greatest  importance  in  curing  any  disease,  that 
a  remedy  should  be  applied  in  the  first  place  to  its 
causes.  But  if  to  any  of  the  evils  to  which  old  persons 


203 

are  subject  a  remedy  can  be  applied,  it  is  but  rea- 
sonable to  expect  that  the  general  system  would  de- 
rive benefit  from  thence;  in  this  way  the  powers  of 
nature  might  be  somewhat  recruited,  and  the  other 
evils  of  old  age,  might,  in  some  measure,  be  re- 
lieved. 

There  is  no  occasion  to  sny  of  how  much  use 
warm  air  is  in  exciting  and  nourishing  the  nervous 
energy.  The  healthiest  and  most  robust,  who  stand 
in  need  of  no  such  assistance,  experience  new  ac- 
tivity both  of  mind  and  body,  from  this  source.  But 
to  the  debilitated  and  the  feeble,  worn  out  by  old 
age,  it  restores  the  decaying  powers,  and  as  it  were, 
fills  up  the  chasm  of  wasted  life.  It  replenishes  and 
preserves  the  powers  of  the  muscles,  sharpens  the 
obtunded  senses,  stirs  up  the  languid  and  almost 
stagnant  circulation  of  the  blood,  quickens  the  pulses 
(in  old  persons  slow)  and  promotes  the  due  motion 
and  distribution  of  the  fluids  throughout  the  whole 
system.  It  restores  also  all  the  secretions  and  excre- 
tions, now  diminished  and  almost  suppressed,  more 
especially  the  perspiration.  In  this  manner,  therefore, 
it  would  be  greatly  beneficial  to  old  persons. 


204 

Nor  does  it  exert  less  power  in  preventing  or  cur- 
ing that  hardness  of  the  skin  and  all  the  solid  parts, 
which  brings  such  evils  upon  the  aged.  Cold  con- 
stricts and  hardens  the  skin  and  solid  parts;  but  mo- 
derate  heat  relaxes  and  softens  them,  as  we  plainly 
see.  If  an  old  person  therefore  would  go  abroad  into 
moderately  warm  countries,  the  mild  air  would  sen- 
sibly render  his  hard,  rough,  dry,  and  almost  imper- 
vious skin,  smooth  and  penetrable;  again,  it  would 
open  the  numberless  more  minute  vessels  now  con- 
tracted, and  almost  closed,  and  open  the  way  for  the 
blood  and  other  humours  to  many  parts  of  the  body, 
almost  dried  up  for  the  want  of  the  vital  fluid.  Hence 
all  the  natural  secretions  and  excretions  now  defi- 
cient, are  promoted,  and  the  power,  contractility  and 
softness  are  restored  to  the  indurated  and  tendinous 
muscles,  now  trembling,  weak,  and  almost  paraly- 
tick.  Nor  is  there  any  doubt  but  that  the  nervous 
system  derives  the  happiest  effects,  from  this  reno- 
vation of  all  the  powers  of  the  body.  It  is  known 
that  to  most  persons,  a  free  distribution  of  the  fluids 
and  perspiration,  ensures  the  greatest  strength  and 
activity  of  mind  and  body.  Nor  would  it  happen 
otherwise  in  old  persons.  In  consequence  of  the  ner- 
vous system  being  in  this  way  regenerated,  the  whole 


205 

system  would  be  reanimated.  Hence  as  before,  the 
hardness  of  the  solid  parts,  and  especially  of  the  skin 
and  arteries,  is  in  some  way  or  other  overcome,  the 
powers  of  the  system  are  increased,  the  return  of  blood 
to  the  heart  is  accelerated  in  consequence  of  the  di- 
minished resistance,  the  pulses  beat  quicker,  and  the 
blood  is  properly  propelled  through  the  minute  and 
extreme  vessels;  so  that  it  opens  for  itself  a  passage 
through  the  almost  closed  up  vessels,  and  renders 
the  hard,  stiff  and  dry  parts,  soft,  flexible,  and  ener- 
getick  as  before. 

Now  if  this  may  be  effected  by  the  perspiration  and 
distribution  to  the  surface  being  greatly  promoted,  it 
appears  reasonable  how  a  change  of  climate  might  be 
of  service  to  the  aged.  For  free  perspiration,  how- 
ever excited,  relaxes  and  moistens  the  skin;  hence 
its  hardness  and  dryness  in  old  age  is  diminished  or 
corrected,  and  the  distribution  of  blood  is  rendered 
more  easy  to  the  external  parts.  It  increases  the 
powers  of  nature  therefore,  and  replenishes  defi- 
ciences.  It  is  also  very  favourable  to  the  nervous 
system,  and  produces  energy  of  body  and  cheerful- 
ness of  mind.  It  perfectly  answers  the  three  indica- 
tions for  cure  which  we  have  advanced,  and  these 


206 

also  reciprocally  promote  each  other.  From  all  these 
circumstances  then,  it  may  be  collected,  a  priori, 
that  a  change  of  climate  would  be  of  infinite  service 
to  the  aged. 

This  theory  is  confirmed,  from  analogy  of  many 
things  which  are  beneficial  to  old  persons,  and 
which  may  clearly  be  referred  to  our  indications. 
We  recommend  in  the  first  place  to  nourish  and 
support  the  nervous  energy:  now  the  liberal  use  of 
wine  tends  to  produce  this  effect;  and  experience 
satisfactorily  proves,  that  wine,  however  injurious  it 
may  be  to  young  persons,  is,  when  moderately  used, 
not  only  safe  for  the  aged,  but  of  the  greatest  utility; 
so  that  it  has  been  esteemed,  and  not  unjustly,  the 
milk  of  old  age.  To  confirm  this  it  is  hardly  neces- 
sary to  adduce  the  authority  of  great  names.  If  how- 
ever there  were  occasion  for  such  adventitious  assis^ 
tance,  the  most  renowned  Sangrado  (of  whose  fame 
there  is  no  one  that  has  not  heard),  affords  remark- 
able proof.  For  after  waging,  th'-ough  the  course  of 
a  whole  life,  a  fierce  and  implacable  war  against  all 
generous  drink,  upon  the  advance  of  years,  he  was 
vanquished  in  the  fight,  and,  forced  by  dire  neces- 
sity, he  implored  favour  and  protection  from  his 


207 

« 

former  execrated  enemy.  If  any  one  is  disposed  to 
reject  the  instance  of  Sangrado,  let  him  yield  to  the 
wise  Le  Sage,  who  was  not  less  deeply  versed  in  the 
medical  art  than  in  a  knowledge  of  mankind.  To 
the  other  indication,  of  promoting  the  perspiration 
and  distribution  of  the  fluids  to  the  external  parts, 
warm  clothing  is  evidently  necessary.  And  it  is  well 
known  to  every  person,  that  this  is  extremely  useful 
to  old  people,  who  should  use  flannel  shirts.  Fric- 
tions also,  and  moderate  exercise,  especially  gestation, 
which  tends  to  the  same  effect,  is  greatly  serviceable 
to  old  people:  so  also  is  the  tepid  or  warm  bath, 
from  which  many  aged  persons  derive  great  help. 

But  the  benefits  which  the  summer  season  brings 
to  old  people,  strengthen  the  theory  more  than  any 
thing  else,  and  are  the  best  proof  of  the  utility  to  be 
expected  from  a  warm  climate.  Upon  the  approach 
of  summer  all  the  evils  which  harass  the  aged  in  the 
winter,  disappear  almost  entirely,  and  old  age  being 
kept  a  little  in  check,  the  scintillating  and  almost 
extinguished  flame  of  life,  is  seen  to  be  animated  in 
them  anew.  Upon  the  return  of  winter,  the  former 
evils  again,  and  now  more  grievously,  press  upon 
them.  If  any  benefit  therefore  is  derived  from  our 


208 

summer,  a  climate  enjoying  a  perpetual  summer, 
promises  much  more  permanent  assistance. 

Finally,  experience  proves  that  this  hope  of  reliev- 
ing old  age  in  some  degree,  and  extending  life  be- 
yond its  natural  termination,  is  neither  vain  nor 
futile*  For  there  are  many  instances  of  old  persons 
having  gone  into  warmer  countries,  and  having  de- 
rived new  vigour  from  the  change,  and  prolonged 
their  ebbing  life.  Some  Europeans  who  have  gone 
to  India,  experienced  unexpectedly  this  beneficial 
relief.  It  is  said  that  the  Spaniards  and  Portuguese, 
when  they  feel  the  presages  of  old  age,  not  unfre- 
quently  go  to  Brazil  or  other  parts  of  South  Ame- 
rica, and  thus  revive  their  wasted  strength,  and 
sometimes  protract  life  for  twenty  years  or  more. 
"  The  fame  of  the  healthiness  of  Brazil  (says  Piso 
in  his  natural  and  medical  history  of  Brazil)  invited 
formerly  not  a  few  old  persons  and  others  in  ill 
health,  to  take  advantage  of  the  air  and  water  of  the 
country,  as  though  they  were  two  of  the  most  pow- 
erful preservatives  of  life  and  health.  For  the  inha- 
bitants soon  arrive  at  maturity:  grow  old  slowly,  and 
without  hoariness  or  baldness.  Hence  it  is  that  long 
after  the  hundreth  year  of  age,  they  enjoy,  not  only 


209 

the  American,  but  even  Europeans  themselves,  a 
green  old  age,  so  that  the  whole  country  deserves  to 
be  called  the  country  of  longevity.''  Nay  it  is  said 
that  lost  fecundity  is  restored  in  the  warm  islands 
of  America.  Which  if  it  be  true,  plainly  proves  how 
powerfully  warm  air  acts  in  reviving  the  powers  of 
the  system. 

A  question  yet  remains  to  be  considered:  at  what 
age  travelling  into  warm  countries  may  be  under- 
taken with  the  greatest  benefit.  I  doubt  whether 
any  age  can  be  particularly  designated;  for  the  use 
of  travelling  depends  on  the  state  of  the  constitu- 
tion and  not  on  particular  periods  of  life;  besides, 
some  grow  old  sooner  and  others  later.  Authors 
divide  old  age  into  incipient  or  green,  and  decrepit. 
They  calculate  the  first  from  the  forty-ninth  year, 
or  from  the  time  when  men  begin  to  grow  gray, 
and  use  spectacles,  that  is  to  say,  from  the  grand 
climacterick  of  life;  the  other  is  computed  from  the 
end  of  this  to  the  last  hour  of  existence.  In  the  first, 
but  few  and  slight  inconveniences  are  experienced; 
yet,  they  may  be  easily  observed,  and  plainly  indicate 
universal  and  approaching  decay.  But  all  the  facul- 
ties both  of  the   mind  and  body,  as  yet  remain. 

2D 


210 

Muscular  motion  is  but  little  diminished;  the  facul- 
ty of  generating,  and  the  appetite  for  food  and  di- 
gestion, continue:  while  in  decrepit  old  age  all  these 
quickly  run  on  to  deterioration.  All  the  powers  of 
the  mind  are  daily  diminished,  and  at  length  alto- 
gether disappear;  all  the  functions  of  the  body  lan- 
guish, and  at  length  cease  to  operate.  It  is  however 
observed,  that  these  changes  happen  sometimes 
sooner  and  sometimes  later;  some  retain  all  their 
powers  and  functions,  even  the  faculty  of  genera- 
ting, almost  to  the  hundredth  year;  some  preserve 
the  form  of  the  body  and  all  the  senses  both  exter- 
nal and  internal,  unimpaired  till  the  seventieth  or 
eightieth  year.  Many  persons  most  manifestly 
suffer  a  deterioration  of  all  their  powers,  before  the 
seventieth  year.  Before  the  fiftieth  year  however, 
scarcely  any  sensible  alteration  takes  place.  I  can 
hardly  believe  then,  that  a  change  of  climate  is  re- 
quired before  the  fiftieth  year;  but  after  it,  there  is 
no  doubt  that  in  many  cases  it  would  be  of  the 
greatest  service.  It  is  much  easier  in  this,  if  I  be 
not  mistaken,  as  in  other  instances,  to  prevent  the 
evils  than  to  cure  them;  and  therefore  travelling 
may  be  begun  with  the  greatest  advantage  between 
the  fiftieth  and  sixty-fifth  years  of  age,  for  the  most 


211 

part  perhaps  about  the  sixtieth,  and  sooner  or  later 
according  to  the  strength  and  constitution  of  the 
person.  But  this  depends  on  different  circumstances, 
as  a  congenital  and  perhaps  hereditary  constitution; 
for  longevity  is  much  more  frequent  in  some  fami- 
lies than  in  others;  yet  it  principally  depends  upon 
the  mode  of  life,  and  innumerable  other  adventitious 
causes. — Yet  I  do  not  in  the  least  doubt  that  travel- 
ling into  warm  countries,  would  be  extremely  bene- 
ficial to  old  persons  already  become  decrepit,  and 
it  is  perhaps,  the  only  remedy  by  which  their  pow- 
ers may  be  restored,  and  their  lives  prolonged. 

Lastly,  it  is  to  be  inquired  how  this  curative  in- 
tention derived  from  climate,  is  to  be  answered,  and 
what  particular  countries  should  be  sought  by  the 
aged.  A  country  warmer  than  our  native  clime,  en- 
joying  a  pure,  mild  and  benign  air,  and  in  other 
respects  healthy,  should  always  be  chosen:  again, 
upon  the  approach  of  old  age,  a  still  warmer  country 
should  be  sought:  nor  do  I  think  that  an  old  person 
should  despair  altogether  till  even  the  hottest  climates 
have  been  tried.  If  any  one  of  our  inhabitants  who 
is  growing  old,  should  go  to  Spain  or  Italy  and  re- 
side there,  I  have  no  doubt  but  that  he  would  expe- 


2\^ 

rience  the  most  beneficial  effects  from  the  change, 
and  would  banish  old  age,  or  at  least  all  the  evils  of 
old  age,  for  many  years.  But  in  process  of  time, 
these  would  doubtless  assail  him  again;  when,  if  he 
should  seek  a  still  hotter  climate,  he  would  by  the 
same  reason,  receive  new  vigour  from  it;  so  that 
when  old  in  Spain  he  might,  by  being  transported 
into  South  America,  derive  assistance  from  that 
change,  and  be  again  renovated. 

Thus  we  may  indulge  the  pleasing  expectation, 
that  health  may.be  procured  even  in  the  hottest 
climes  on  earth;  that  man,  when  threatened  with  the 
decrepitudes  of  old  age,  may  avert,  or  at  least  alle- 
viate them,  by  deserting  his  native  soil;  and  that  he 
might  prolong  a  life,  the  shortness  of  which  is  a 
source  of  perpetual  and  querulous  regret,  for  twenty 
or  perhaps  for  thirty  years,  by  availing  himself  of 
the  friendly  influence  of  a  foreign  and  more  genial 
sun. 


THE  END. 


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